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April 23, 2009

What Will Happen to Specialized Health Agencies with a Major U.S. Foreign Assistance Reform?

Posted by Ruth Levine in Global Health Tags: , , , , ,

My colleague Steve Radelet testified eloquently before the House Foreign Affairs Subcommittee on Africa and Global Health today, making a strong case for shaping up U.S. foreign assistance programs, and development policy more generally, in pretty fundamental ways. The “asks,” as we say in Washington: A global development strategy; a new Foreign Assistance Act reflecting the realities of 2009 rather than, say, 1961; a consolidated foreign assistance architecture that’s fully professional and capable of responding in nuanced ways to country contexts; full engagement with multilateral institutions; and resources commensurate with a strong and effective set of policies and programs. This should be music to the ears of many of those who work in the field of development and/or bemoan the distance between the potential for positive U.S. engagement and the reality.

For global health, there’s no question that it would be of great value to have greater coherence in U.S. activities, and for development as a whole to have a higher political profile and be better resourced. But as grand plans are made and, hopefully, brought to fruition, we need to protect and even enhance the role of the best-performing elements in the current fragmented system. In other words, we want to make sure that a coherent whole is more than the sum of the parts, not less. Read More…

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March 13, 2009

Hanging in the Balance: Who Will Deal with Child Malnutrition?

Posted by Ruth Levine in Maternal & Child Health Tags: , , , , , , ,

Weighing an InfantHow can it be possible, in 2009, that almost half of all Indian children under three years old are underweight or severely underweight, and that child malnutrition accounts for more than one-fifth of the total burden of disease in that country? Something like three-quarters of all preschool children in India have iron-deficiency anemia, which impairs learning, and more than half have at least mild vitamin A deficiency. Given India’s place as one of the fastest growing economies in the world, the persistently high levels of malnutrition among children — close to double that of sub Saharan Africa — have to be cause for alarm and puzzlement. And the extraordinary vulnerability of Indian children, as manifested in these figures, holds in it a warning for what might happen as economic growth slows. Any claims of progress in child health have to be tempered by these sobering facts. A feature in yesterday’s New York Times focuses on the problem and describes it well, but leaves the questions — why and what can be done? — for others to answer.

Who those “others” are in the field of nutrition is not at all clear, in India or elsewhere. Nutrition has long been a subject area that has fallen between the stools: related to health, yes, but never at the heart of what Ministries of Health consider their main mission. Moreover, a health-centric response to under-nutrition — which often boils down to providing medical care for severely malnourished children, promoting breastfeeding among new mothers, and distributing vitamin A capsules — usually fails to address the household food consumption patterns that are shaped by everything from women’s access to income to the way food is produced and distributed. It is everyone’s job, and no one’s.
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