Tag Archives: MDGs

Mothers, Midwives and Mobile Phones

By Associate Professor Arul Chib, Director, Singapore Internet Research Centre Assisted by Megan Fernandes, Graduate Student, Wee Kim Wee School of Communication and Information, Nanyang Technological University

“Almost 800 women die every day due to complications during pregnancy and childbirth” (WHO, 2014). 99% of these deaths occur in developing countries. These grim statistics betray the state of maternal healthcare and the circumstances under which many mothers try to bring their children into the world. A great majority of these deaths could have simply been averted had there been some form of skilled healthcare or obstetric care available to these expecting mothers.

For instance, in Aceh Besar, Indonesia, where I focused on rehabilitation efforts post the 2007 Tsunami, the stark lack of basic infrastructure and facilities available to mothers was immediately apparent. In other projects in India, China, Nepal, Papua New Guinea and Thailand, I was met with similar circumstances – derelict hospital infrastructure, threadbare facilities and an inadequate number of staff, many of whom were under-trained.

With high issue salience in the international development agenda – for example, Millennium Development Goal 5 is devoted to improving maternal health by reducing the maternal mortality ratio and increasing universal access to reproductive care – there is admittedly a lot of effort going into alleviating the problem.

But working in such low resource environments has taught me that mere injection of infrastructure or financial resources will not remedy the issue at hand. The issue of maternal mortality, or for that matter any development related issue we are grappling with today, is more nuanced and multi-faceted.

In exploring the various ways the issue can be approached, the role of Information Communication Technologies (ICT) stands out sharply. The rate of uptake of ICT devices – especially the now ubiquitous mobile phone has been nothing short of disruptive. Put in a healthcare context, ICTs have immense potential to be harnessed. The adoption and use of ICTs to achieve positive outcomes in healthcare delivery across the world has already been documented.

In making the case for maternal healthcare, let’s look at what decades of experience say: it is advised that pregnant women be provided with comprehensive care in the form of regular gynecological visits during pregnancy, access to skilled birth attendants during delivery, etc. However, the realities on the ground in many developing nations present a sharp contrast. Rural healthcare systems in such regions are unable to make available formal and adequate reproductive care. Without many of the required in-house facilities available locally, rural dwellers in developing countries need to travel to distant urban locations for access to service and care. In many cases such travel is not affordable or feasible and what remains are rural mothers-to-be cut off from access to the world at a time when it is most needed.

But the ubiquitous mobile phone is slowly trying to bridge this distance.

Evidence is emerging on how local healthcare workers are using mobile phones to access information and expert advice from their superiors in other locations. Mobile phones seem to be conquering the rural-urban distance barrier in two ways: they bring the urban healthcare center closer home in the form of professional advice directly from the expert and they improve the skills of the local, rural healthcare worker enough to the point that she can then make those important decisions by herself when the opportunity arises next time around.

Revisiting the case of Aceh, where we administered a mobile healthcare (mHealth) intervention for midwives, I found that mobile phone use and appropriation by the local midwives benefitted the local healthcare system by allowing for greater time efficiency, greater access to expert advice and finally improved relationships between the midwives, the community and with doctors.

I often quote a particular incident narrated to me by a participating midwife from the intervention in Aceh to illustrate the immense promise of the mobile phone:

“It was a high risk delivery. I called Ms. A [fellow midwife] then I called Ms. B [senior midwife] … When the baby came out, he didn’t cry, he had asphyxia. We thought he was already dead. The blood was all over my mobile phone because I kept holding it. I called an ambulance. The mother was bleeding. Ms. A took the baby with her and went with the ambulance. Imagine if I handled that patient alone, probably both the mother and the baby would have died.”

Despite the powerful narrative, it serves to mention that the mobile phone in itself is no single panacea to the problem. The problems that technology interventions are usually designed to address are but infrastructural problems. Most of the discourse surrounding this field today is in that order. However, there exists a social layer to the structural problem and this is where we should be turning our energy and efforts as well.

For example, we witnessed a strong patriarchal streak that ran in the community – the village chiefs [all male] were loath to allow the midwives [the females] possession of the mobile phones. The midwives employed strategies to protect the social order–projecting the fact that the mobile phone was ‘not theirs’ in that they resorted to ‘forced sharing’ strategies wherein they thrust the phone to their sons or other members of the community in a bid to escape the attention and questions they could be faced with. We observed other social dimensions to the problem in the form of ‘hierarchies’ or so called ‘power distance’ issues between those higher up in the medical fraternity and those at the junior or more rural levels.

Such ‘social’ problems are bound to exist well after the ‘technological or infrastructural’ problems are solved. Unsurprisingly, ‘technological or infrastructural’ solutions’ sometimes create ‘social’ issues.

What is required are interventions that adopt a more holistic approach towards resolving developmental issues. This requires effective problem solving with an entire system working in tandem: participation from a policy maker to a grassroots worker, from a gender expert to governance experts as no single issue can be resolved uni-dimensionally. From the perspectives of donors and governments, the conversation has to shift from the quantum of funds allotted and spent to the effectiveness of the outcomes this allocation has brought about. On its part, the research fraternity which I represent can help by pursuing more action oriented research and engaging more effectively with policy makers on the results of such research.

Dr. Arul Chib, Associate Professor at Nanyang Technological University, and Director of the Singapore Internet Research Center, studies the adoption of technology for positive development outcomes and examines the impact of development campaigns delivered via a range of innovative information and communication technologies (ICTD or ICT4D), focusing on mobile phone healthcare systems particularly in resource-constrained environments of developing countries.

Dr. Chib is the recipient of the 2011 Prosper.NET-Scopus Award for the use of ICTs for sustainable development, and a fellowship from the Alexander von Humboldt Foundation. He is the General Conference Chair for ICTD2015, taking place in Singapore 15-18 Ma, 2015. More details on his work may be found here, here and here, Dr. Arul Chib can be reached at ARULCHIB@ntu.edu.sg or (+65) 65148390

Building on the Momentum of the MDGs

By Michel Anglade

13 Mar 2013 (1)

Since the adoption of the UN Millennium Development Goals in 2000, we have seen improvements to the lives of millions globally. About 600 million more people have been lifted out of poverty, 56 million more children are going to school and millions of households have access to clean water.

Indeed, these successes prove that political will and commitment to set goals can bring about real change. And as the 2015 deadline for these UN MDGs loom, the international community must start critically reviewing these goals and discuss what the next commitment period will bring.

That is why Save the Children, along with ONE (Singapore) and the Singapore Institute of International Affairs, held a panel discussion on February 15th, 2013 to discuss the opportunities and challenges in the Post-2015 MDG agenda. During this discussion, Save the Children presented its report ‘Ending Poverty in Our Generation’, which lays out our proposal for the post-2015 agenda. Beyond these suggestions, however, it is my belief that we should first lay down the key principles to which these goals should be written.

Firstly, are all children given a fair chance to survive and thrive? Despite huge reduction in absolute poverty numbers, inequality has been on the rise. Save the Children’s ‘Born Equal’ report, published last September, showed that the overall gap between rich and poor children, globally, has grown by 35% since 1990 – nearly double the gap between adults – meaning that in some countries more than twice the number of poor children die before the age of five than rich children. Progress needs to reach the poorest 20% before we can safely say that all children have been given a fair chance to survive and thrive.

Secondly, Post-2015 goals cannot be seen as separate targets for separate sectors because they are inextricably linked; instead, they need to be seen as parts of a whole. A hungry child is less likely to go to school and achieve good learning outcomes; he is more likely to fall ill; and as he are also more likely to be poor, he will have less access to health services, clean water, nutritious food for physical and mental development and the result is a vicious cycle of poverty for generations to come.

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During the panel discussion, Michael Switow pointed out – and quite rightly so – that perhaps indicators are not enough for development. A child that has US$1.26 (US$0.01 more than the agreed target) could be considered ‘lifted out of extreme poverty’, but 10% inflation means that they would just be as food insecure as they were before. Instead, a rights-based approach could be necessary to ensure that women and children have access to what they need in order to survive and thrive. This is very much in line with Save the Children’s vision of a world in which every child attains the right to survival, protection, development and participation. Every child must have access to schools, clinics, social protection, nutritious food and a voice.

Accountability should be at the core of the framework. In order to hold world leaders to their promises, we need a robust accountability mechanisms rooted in regular collection of disaggregated data in order to track progress, all of which require investment and resources from the state.

Lastly, environmental sustainability of development is crucial as human health, survival and activities are dependent on our earth’s natural resources. Increased environmental exploitation is often viewed as a necessary process in development as people require more fuel, food and other material goods like electronics. And little has been done to improve the sustainability of our world. Of the 20 countries most at risk from climate related disasters by 2015, 19 have large numbers of absolute poor. As such, development projects should at the core of it, be built around environmental sustainability and low-carbon development.

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development may not be limited to the environment. Investment in women, for instance, will go a long way in sustaining development. As Georgette Tan said: “Women need to be empowered: They need an education to start, they need access to a bank account, access to finances and credit. They need to be given access to technology and they need to understand that they have a role to play…It’s about giving them the leg up, not just about the hand out.” Indeed, the case for investing in women has been made many times over; 90% of women’s income is reinvested in her families as opposed to about 40% of men’s income. Women invest in their communities, which helps create many more opportunities for other women and children in those communities.

Millions have benefitted as a result of the Millennium Development Goals. Let us capitalise on this momentum so that 6.9 million children no longer die each year from preventable causes, 300,000 mothers do not die needlessly, and millions of hungry have access to the nutritious foods they deserve.

Save the Children’s report, ‘Ending Poverty in Our Generation’, can be downloaded here.

Michel Anglade is the Campaigns and Advocacy Director at Save the Children Asia

ONE (S) urgent call to Commonwealth leaders to address health related MDGs

Tell the Commonwealth it’s time to take urgent actions to meet the MDGs!
5 Nov 2011

ONE (SINGAPORE) has joined some 400 civil society organisations and anti-poverty campaigners from across the globe in calling on leaders of the Commonwealth to take urgent actions to ensure that the health targets of the Millennium Development Goals are met for all two billion Commonwealth citizens by 2015.

While increased funding and attention to health issues have led to progress — including a significant reduction in child mortality, fewer deaths from malaria and greater access to life-saving drugs for people with HIV — much more work needs to be done in order to meet the MDGs.

Specifically, the Open Letter to the Commonwealth leaders calls on each country to take the following actions:

  1. Meet the minimum W.H.O. (World Health Organisation) standards, including providing at least 2.3 professional health workers for every 1000 people.
  2. Provide universal access to family planning services and ensure that all women are able to give birth with a skilled attendant.
  3. Scale up responses to tuberculosis and HIV
  4. Fully fund the Global Polio Eradication Initiative, which is working to eradicate the second disease in human history
  5. Ensure that all citizens have access to safe drinking water and effective hygiene by 2015.
  6. Improve food security and nutrition by increasing support to small scale agricultural producers, particularly women.

The open letter was organised by Make Poverty History Australia and signed by Oxfam, ONE (SINGAPORE) and Save the Children, among other organisations. MPH Australia planned to present it to the Australian government prior to the Commonwealth Heads of Government Meeting (CHOGM) in Perth at the end of October. Unfortunately, the Australian Prime Minister’s Office and Ministry of Foreign Affairs declined requests for a face-to-face meeting. The Open Letter and an online petition will now be submitted to Australian Prime Minister Julia Gillard.

You can add your voice to the online petition through Friday 11 November.

The Commonwealth includes 54 nations, largely former British colonies in Africa and Asia. Singapore joined the Commonwealth in 1965 and the Singapore Declaration of Commonwealth Principles provided the association with a set of ideals and shared values in 1971.


“Don’t Cut Aid,” ONE (S) and int’l civil society tell Japan

As Japan prepared to host an international meeting on the Millennium Development Goals, ONE (SINGAPORE) joined with civil society groups in Japan and from across the world to call on the Japanese government to honour its international aid and development commitments.

Following the March earthquake and tsunami, Tokyo announced that it would cut overseas aid in order to concentrate on relief and reconstruction at home. These cuts – including a 100% reduction in funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria – will cost lives and reverse gains made towards the achievement of the MDGs.

“The Japanese government must not abandon its commitments to eradicate poverty and disease in impoverished countries,” says Masaki Inaba of GCAP Japan. “My colleagues and I were shocked to see our government cut assistance to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Global poverty is a ‘silent tsunami’ which Japanese aid has been fighting. Pitting domestic reconstruction against overseas aid is the wrong approach. Japan must be do both.”

“Much as we understand the rationale behind these cuts, we urge the Japanese government not to abandon its commitments to eradicate poverty and disease in impoverished countries,” adds ONE (SINGAPORE) President Vernetta Lopez and co-founder Michael Switow in a letter to Japan’s Ambassador to Singapore, Mr Yoichi Suzuki. “By taking action now, Japan can save lives and set a prime example of commitment and solidarity for the protection of people’s lives and the elimination of disease, poverty and conflict.”

Read the full text of ONE (SINGAPORE)’s letter as well as a letter to Japanese Prime Minister Naoto Kan signed by the co-chairs of the Global Call to Action Against Poverty.


The G8’s Aid Report Card

Condemnation and commendation: G8 countries show mixed results in efforts to meet aid targets

20 May 2011 (1)

In 2005, the G8 and EU made a set of historic commitments to help sub-Saharan Africa meet the Millennium Development Goals.  As the G8 prepares to meet in Deauville, France on 26-27 May, we would like to share a report with you from ONE in the United States about how the G8 countries are doing on their commitments.

Here are the main findings of the 2011 DATA Report:

  1. Collectively the G7 delivered 61% of the increased aid they promised in 2005 to sub-Saharan Africa by 2010. The increases were largely a result of the UK making commendable progress towards its very ambitious target and the US, Japan and Canada surpassing their relatively modest targets. Italy’s performance is condemnable, falling far short of its promises to the world’s poorest people. France and Germany have also failed to meet their ambitious targets.
  2. The failure of the G8 to keep their promises deprived the world’s poorest people of $7bn in financing for effective and life-changing programmes in 2010 alone.
  3. Despite the overall shortfall, there have been historic increases in aid to sub-Saharan Africa since 2000, and especially since 2005 and the promises of the Gleneagles G8 Summit which was a response to the global Make Poverty History campaign.
  4. Much of this smart aid went towards programmes that are delivering real results in sub-Saharan Africa. Together with African efforts, aid has helped to avert the deaths of 750,000 children from malaria; allowed 46.5 million children to enroll in school for the first time; provided 4 million Africans with anti-AIDS drugs; and helped boost agricultural productivity by 50% in 17 African countries.
  5. Emerging economies such as Brazil, India, China and Russia have been steadily increasing their aid to sub-Saharan Africa in recent years, along with increased trade and investment with African countries.

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France, Germany and Italy “must urgently get back on track by setting out clear timetables to meet the promises they made to give 0.7% of their national incomes as overseas aid by 2015,” says ONE Executive Director Jamie Drummond. “At the same time, non-European G8 countries like the US, Canada and Japan should set new, ambitious commitments for aid to sub-Saharan Africa.”

However even if G8 donors meet all their existing and future promises on aid, much more money needs to be invested in developing countries if we are to reach the Millennium Development Goals and pull millions of people out of poverty.  Innovative financing measures — like a Robin Hood Tax and African diaspora bonds — need to be adopted.

“We welcome the momentum on innovative finance for development at the G20,” adds Mr. Drummond, “even though there are some questions over whether President Sarkozy’s new focus on this area is in part an attempt to divert attention away from France’s failure to meet its fair share of Europe’s aid targets. That is why we are calling for real and measurable progress to be made before the end of 2011.”