Poverty and health

World Food Programme (WFP) Executive Director Josette Sheeran has urged doctors and medical experts to put their knowledge to work to support the battle against malnutrition, a factor in 10,000 child deaths every day. Speaking at the Royal Society of Medicine in London, Sheeran said that the world already had the ability and knowledge to tackle the challenge of malnutrition. What was lacking was the coordinated focus and political will, she said. 'We need to harness what we know – take the knowledge that we have right now and put it into action. We cannot wait,' she said in remarks to a breakfast meeting with a group of eminent doctors and medical experts. If a child under two is deprived of the nutrition needed for mental and physical growth, the damage is irreversible, Sheeran noted. 'For the world's bottom billion, can we take the technology and what we know, and ensure that there is access to nutrition? And can we stand with those under two year olds and at least make sure they are getting a shot at life?' The costs of undernutrition are high. Without adequate nutrition children cannot learn in school, HIV and AIDS drugs don’t work, populations are more vulnerable to disease and economic growth is undermined, she added.

The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings by identifying factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. Methods The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy 'wantedness', and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.

Malawi has gone from bountiful maize crops to food insecurity in the past seven years. Thanks to increased farm subsidies for small-holder farmers in 2004, Malawi harvested a bumper crop the following year. But the author reports that subsidies fell thereafter and Malawi became a net importer of maize, with domonishing agricultural outputs. What can be learned from Malawi’s story? With a population of more than a billion, will Africa produce enough food for its people? The author argues it is possible, but under several conditions. First, an essential ingredient for success in agriculture is strong political will at the highest level. Second, while foreign funds help to feed the hungry and revive agriculture in Africa, food security is argued to be too important to be left to the generosity of external partners. It also requires the same importance and resources as national security. Africa needs a strong food policy backed by resources from African Union (AU) members, to be invested in institutions that promote agriculture. One tangible AU response has been the Comprehensive Africa Agriculture Development Programme (CAADP), which requires countries that sign up to it to spend at least 10% of their national budgets on agriculture.

The sanitation sector in South Africa is currently regulated by three policy documents, namely the White Paper on Water Supply and Sanitation (1994); the White Paper on a National Water Policy of South Africa (1997) and the White Paper on Basic Household Sanitation (2001). These documents provide procedures, rules and allocation mechanisms for sanitation, implemented through laws, regulations; economic measures; information and education programmes; and assignment of rights and responsibilities for providing services. After several years of implementation, a number of challenges and unintended consequences were identified. The regulatory responsibilities were unclear, shifting between departments. Devolving responsibility for implementation to local government resulted in significant changes in the sector. Increased urbanisation is noted to increase stress on urban sanitation systems, but so too is changing human settlement in rural areas placing increased strain on small and limited sanitation systems. The department thus argues for policy review to address these challenges to deliver sanitation.