Mothers and their children gather at a community nutrition centre in the little village of Rantolava, Madagascar, to learn more about a healthy diet. Credit: Alain Rakotondravony/IPS
This kind of integrated health care model is now becoming the norm in the district. Up until recently, families like the Awino’s, who are living with HIV, went to one facility for HIV care and treatment, another facility for prenatal care, another clinic for their baby’s routine health and yet another clinic for any illnesses.
As a result, a child who was not thriving because of underlying HIV and arrived at the sick baby clinic was unlikely to be tested because the facility was not an HIV clinic. Keep in mind, the journey to the clinics is almost always arduous and the likelihood that women return, or come at all, cannot be taken for granted.
Healthy women and healthy babies build healthy communities. We all know this. But we also know that many of the systems in place to keep women and children healthy are fragmented and don’t adequately address the needs of those they serve.
These are the glaring inefficiencies we have considered this week at the Forum of the Partnership on Maternal and Newborn and Child Health in Johannesburg, South Africa.
Simple solutions to align ‘service delivery entry points’ within larger systems could make a huge difference to mothers, to children’s health, and to a more productive society.
Integrated packages of care save lives by strengthening systems to identify and address potential problems and to intervene early. Combining interventions for women and children in the same place, through reproductive, maternal, newborn and child health services as well as infant feeding/nutrition and early childhood services can address critical gaps and create synergies in service delivery. Such interventions include those related to HIV, TB, malaria, syphilis, pneumonia, diarrhea and malnutrition.
The Double Dividend is one example of an initiative designed to improve maternal and child survival by aligning reproductive, maternal, newborn and child health services, as well as nutrition and HIV related services.
Infants born to untreated HIV-positive mothers, whether living with HIV or not, can have a higher risk of dying than infants who are not exposed to HIV, just as untreated HIV-positive pregnant adolescents and women have an increased risk of dying in pregnancy or child birth.
Pregnant women are much more likely to visit a clinic for antenatal care, just as infants do for immunization and sick visits. We need to seize these precious opportunities to care for the children and their mothers holistically.
Good opportunities to improve linkages between maternal, newborn, child health services to address key diseases and conditions include:
- Linking staff training for various services to integrate service delivery and management
- Interconnecting public information about services
- Using many different types of services as opportunities to reach families, and
- Promoting community outreach and support systems.
This not only will save lives like those of Benta and Ronny, it will also save money. The goal is to yield benefits in terms of the health of both mothers and their children through high quality and efficient interconnected systems which promote human rights and accountability.
No matter how you look at it, this way ahead is a win-win.
Dr. Chewe Luo is a senior adviser for HIV with UNICEF in New York. She has previously served with UNICEF as HIV regional adviser for Eastern and Southern Africa in Nairobi and as HIV technical adviser in Botswana. Earlier in her career, she worked as a pediatrician at the University Teaching Hospital in Zambia.
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by Mitchell Plitnick
There was a real diplomatic blowup in the Knesset last week, when Naftali Bennett led a walkout of the chamber by his HaBayit HaYehudi party during a speech by European Union Parliamentary President Martin Schulz. The comment Schulz made that elicited his response was this: “A Palestinian youth [...]]]>
by Mitchell Plitnick
There was a real diplomatic blowup in the Knesset last week, when Naftali Bennett led a walkout of the chamber by his HaBayit HaYehudi party during a speech by European Union Parliamentary President Martin Schulz. The comment Schulz made that elicited his response was this: “A Palestinian youth asked me why an Israeli can use 70 cubic liters of water and a Palestinian just 17. I haven’t checked the data. I’m asking you if this is correct.”
Is this just another example of Israeli hyper-sensitivity and over-reaction? In fact, it is not. At first glance, this seems like a foreign leader framing a question, one that seems to be regarding an issue that makes Israel look no worse than frequent statements about settlements and foot-dragging on the peace process. It actually touches on an issue that is at the very heart of the Israel-Palestine conflict, but that is too often overlooked. That issue is water.
When one mentions water in conjunction with the Middle East, there is always this “oh, yeah” reaction as people remember that this is probably the single most important issue in the region. But it is too rarely considered in political analyses. It isn’t discussed often enough in the context of the roots of the Israel-Palestine conflict, but it is absolutely fundamental to Israeli policy and Palestinian dispossession.
People are usually puzzled as to why Israel risks international isolation and opprobrium in order to maintain its occupation. Is it religious zeal? Nationalistic fervor? An obsession with security considerations that Israel’s military might has transcended and that are based in military thinking that is a half-century out of date? All of these are very real factors. But somehow, water is never mentioned as more than an afterthought (and I confess, I am as much at fault as my fellows in this regard).
But anyone who has ever been to Israel and also to other countries in the region knows that Israel, although it certainly needs to be more water-conscious than most Western countries, lives a more water-rich lifestyle than any of its neighbors. Talk to older Israelis who remember things before 1967; that was a different Israel in many ways, and water was a big issue. The difference between Israelis and Palestinians in the West Bank and East Jerusalem is even more starkly visible; the contrast between homes with lush lawns and, in some cases, swimming pools in the settlements, and the arid homes of Palestinians with water cisterns on the roofs that are not always filled on schedule and often hold less than what is required between fillings is quite striking.
Today, and for more than four decades now, many of Israel’s major cities get a huge portion of their water from the mountain aquifer in the West Bank. Other water sources in Israel are dependent on this aquifer, and a few other smaller ones in the West Bank as well (see the map here). So not only would abandoning the West Bank mean that Israel loses a major portion of its water supply, the Palestinians would actually have the ability to control the sources of some water that is drawn within Israel’s internationally recognized boundaries.
That’s why water is always a sensitive issue. It’s made more so, of course, because, while the Palestinians and Israel “share” this major water resources, consumption is not at all equal. According to the Israeli human rights organization, B’Tselem, daily per capita water consumption among Palestinians connected to the water grid in the West Bank for domestic, urban, and industrial use is some 73 liters. In areas in the northern West Bank, consumption is much lower. In 2008, per capita daily consumption was 44 liters in the Jenin area and 37 liters in the Tubas area, according to B’Tselem’s statistics. Today it’s about 38 liter per day in Jenin, but 169 in Jericho, which is very close to Israeli usage. About 113,000 Palestinians are not connected to the water grid, however, and their daily consumption is a mere 20-50 liters.
Most Palestinian water consumption is thus considerably lower than the WHO’s and USAID’s recommended bare minimum of 100 liters per day, and considerably less than the Israeli average of about 183 liters per day. So, yes, Schulz overstated it when he said Israelis consume four times as much per capita as Palestinians. They “only” consume between 2.4 and 3.5 times as much, with the gap between the average Israeli and the worst off Palestinian being about 7.5 times as much. And, let’s remember, that this is a resource that Israel took from the Palestinians when they occupied the West Bank. Before that, under Jordanian rule, and for the most part under the British Mandate, West Bank Palestinians enjoyed full access to the water resources in their area.
The conditions described above apply only in the West Bank. In Gaza, the situation is much worse. Gaza depends almost entirely on the coastal aquifer, which is also used by Israel and Egypt. The Palestinian Water Authority pumps more than three times the aquifer’s replenishment rate per year, and even that, due to unreliable supplies of electricity, water supply is erratic on a daily basis.
Over-pumping of that aquifer is a long-term problem, one that pre-dates Israel’s occupation of the Strip in 1967, but is now reaching crisis proportions. According to WHO findings, the Strip is expected to exhaust its supply of usable drinking water in 2016. UNICEF says that at present, 90% of the water from the coastal aquifer is unfit for human consumption. The majority of Gaza’s citizens have to buy water from vendors, with some paying as much as one-third of their income on water.
The pollution of the aquifer will, of course, also have a significant effect on Israelis and Egyptians, even beyond the fact that they will have to find alternative water sources. The World Bank funded the construction of a water treatment plant to alleviate part of this problem, but although the plant has been completed, it stands idle, caught in the middle of a dispute between Israel and Hamas over Israel providing increased electricity to the Strip in order to run the plant (Gaza still depends on Israel for most of its energy needs).
One can expect that Israel will eventually address this issue. The siege has, from the beginning, been carefully managed by Israel to ensure the deprivation of Gaza’s population while avoiding the sort of massive death and illness that might create international outrage and force Israel to act. But the water issue, as it involves both Gaza and the West Bank, threatens to turn into something much greater.
Although some groups, including the International Committee of the Red Cross, had warned years before the outbreak of violence in Syria of the extent of destabilization that the water crisis there could cause, such warnings were not loud enough and went unheeded by all those world leaders (including the Obama administration) who are currently wringing their hands about their “inability” to take action to stop the ongoing civil war there. In the Occupied Palestinian Territories, a similar dynamic is currently underway, and it is complicated by the occupation, the concomitant restrictions on movement and on Palestinian access to water (while Israeli needs have not yet been impacted significantly) and by the continuing and increasingly petty bickering between the Palestinian Authority and Hamas.
The subject of water is therefore a touchy one for Israel on many levels. Not only is it an issue of unequal access to this most crucial of resources, but it also illustrates the difficulties of truly separating Israel and the Palestinians. Indeed, when it comes to water, it will be impossible for Israel to end the occupation and maintain its current standard of living with regard to water. It will also be impossible for any Palestinian entity to survive without significant external investment in irrigation, water treatment, desalinization, and other methods of conserving and treating water. In other words, when it comes to water, it is highly unlikely that Israel and the Palestinians can separate from each other as the Oslo formulation of a two-state solution envisions.
It has often been said that in the 21st century, water will become one of, if not the leading cause of war. That is nowhere more evident than in the Israel-Palestine conflict. The warning signs are all there now, before things spiral even farther than they already have. But water can also become the basis for a pressing need on which Israelis and Palestinians can cooperate. That can lead to a practical solution and, while that can be a single state as some advocate, it can also be a two-state vision, albeit one that is very different from the Oslo formulation. Two states existing in cooperation and mutual dependence is the key to avoiding more conflict and opening the door to healing. That, rather than the obsessive separation of the two peoples, can exist in two states and can lead to peace. Water can either be the spark for increased conflict or the key to a better future for both peoples. This is the choice facing Israelis, Palestinians and, yes, the United States.
Addendum: The Israeli journalist Amira Hass, writing in Ha’aretz, lists some very pertinent and basic facts about the use of water and the massive inequality therein between Israel and the Palestinians. She makes it quite clear that the situation is much more dire than even Schulz realizes and that Israel is going to great pains to ensure that people (including most Israelis) don’t know how bad it is. In any case, the article is essential reading for anyone who wants to understand this crucial issue. It should be accessible, but if people have any trouble, please contact me through my web site and I will gladly send you a summary of the facts Hass relays.
Photo: Rooftop water cisterns in Jenin, a Palestinian city in the West Bank.
]]>Two weeks ago I met Jeanne and Hubert Mwangaza in a poor suburb of Lubumbashi, Democratic Republic of Congo (DRC), where I was on a video assignment with UNICEF. Hubert could not wait to tell me – on camera – [...]]]>
Two weeks ago I met Jeanne and Hubert Mwangaza in a poor suburb of Lubumbashi, Democratic Republic of Congo (DRC), where I was on a video assignment with UNICEF. Hubert could not wait to tell me – on camera – how proud he is that all his children are HIV negative. Him and his wife are both HIV positive.
Courtesy: Chiara Frisone
When they met, Jeanne had given up any hope to have children. Hubert convinced her that prevention of mother-to-child transmission could give them HIV-negative babies.
He accompanied Jeanne to ante-natal visits and checked that she took her antiretroviral medication regularly. He was with her during each birth of their three daughters and when they were tested for HIV.
For her last-born, Marie, Jeanne was put on the new revolutionary one-pill-a-day antiretroviral treatment known as life-long treatment.
Women on this new regimen are able to breastfeed their babies safely for six months, provided that they adhere to the treatment. Marie has to take another HIV test at six and 18 months, but Hubert is confident that his little girl, like her elder sisters, is born without the virus.
Only a few years ago, this family’s story would have been the exception rather than the rule. Today, Botswana, Ghana, Namibia and Zambia have virtually eliminated new HIV infections in children, and a few more countries in Africa are close behind them.
However, children’s access to antiretrovirals remains unacceptably low – only three in 10 eligible children receive HIV treatment in many of the most affected countries.
Dramatically improving these numbers is among the top goals for the 22 priority countries targeted by the Global Plan that aims to elimination new HIV infections among children by 2015 and keeping their mothers alive.
Securing child health is only a fraction of the job to be done. Too many women are getting infected and not all pregnant women living with HIV are accessing life-saving treatment.
Between 2009 and 2012, there has been no decrease in the number of new HIV infections among women. We need to redouble efforts in preventing HIV among adults- and especially young women- through a combination of safer sexual behaviour, voluntary medical male circumcision and use of antiretroviral therapy among discordant couples.
Voluntary family planning services for all women, including women living with HIV, can prevent unwanted pregnancies and help reduce new HIV infections among children. Young women in particular should have access to voluntary planning and comprehensive information about preventing HIV.
In the next months, Inter Press Service Africa, in collaboration with UNAIDS, Unicef and UNFPA, will tell many stories like Jeanne and Hubert’s — stories of courage and resilience that will rekindle our hope that a generation of babies born without HIV to healthy mothers living with HIV is around the corner. Other stories will highlight challenges to solve if we are to turn that corner by 2015.
The Countdown to Zero New HIV Infections project explores community, policy and expert efforts across Africa to achieve these goals through in-depth feature stories, portraits and testimonies.
Follow the stories here: http://www.ipsnews.net/news/projects/countdown-to-zero/
Enter the conversation:
Facebook: www.facebook.com/countdowntozeroHIV
Twitter: @ZeroNewHIV
]]>As always with rich reports like these, there is too much valuable info to squeeze into one article, so I’m making use of this space to draw [...]]]>
UN Photo/Stuart Price
Some may have seen my most recent article providing some highlights of a new UNICEF report on the global progress in reducing child mortality since 1990.
As always with rich reports like these, there is too much valuable info to squeeze into one article, so I’m making use of this space to draw attention to some more statistics that I think are worth mentioning.
For example:
:: Half of all under-five deaths occur in only five countries.
:: These countries are India, DRC, Nigeria, Pakistan and China.
:: 40 percent of all children dying under the age of five die within the first 28 days after birth.
:: UNICEF estimates that by 2050 one in three children will be born in sub-Saharan Africa.
Now, onto some positive news. Here are 12 former high-mortality countries that have made strides in reducing under-five mortality and are close to achieving Millennium Development Goal 4 by 2015.