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New Social Compact

To Realize Universal Health Coverage, Surgical NGOs Must Play a Crucial Role

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Authors: John L. Dutton, Desmond T. Jumbam and Libby Bunker

The COVID-19 pandemic has eroded and exposed fragile health systems globally.

Health care workers have been overwhelmed by the sheer numbers of patients needing intensive care, which has devoured already limited resources, stretched tenuous supply chains and spread thin the efforts of those one the front lines.

Sadly, essential surgical services, including live-saving surgeries to repair cleft lip and cleft palate, cesarean sections and many more, which were already in strikingly short supply, especially in low- and middle-income countries, have been made worse by the pandemic.

Much progress and change need to be made so that reactive health care systems can become proactive in the face of crises. That paradigm shift is also essential if we are to achieve the U.N.’s lofty goals for universal health coverage – access to the health services that all people need, when and where they need it without experiencing financial hardship – by 2030.

Surgical nongovernmental organizations (NGOs) must play a key role in achieving these goals.

COVID-19 has directly led to significant disruptions in surgical care. Data from 112 countries shows that half of these countries are providing 70% less surgeries than before the pandemic with the greatest reduction in low-income countries. Most of these interruptions have been justified, as evidence from The Lancet has shown that half of patients who become infected COVID-19 before or after surgery develop pulmonary complications and are more likely to die after an operation.

Prior to the pandemic, more than 100 million additional surgical procedures were needed annually in low- and middle-income countries. Current surgical delays exacerbate this unmet need: Even more mothers needing cesarean sections due to obstructed labor, more children needing their appendix removed due to infection, and more people requiring trauma surgery to repair severely fractured bones are without access to life-saving procedures.

Tragically, these and millions of others are at risk of death or disability because health systems lack adequate infrastructure and skilled health workers to address the surgical needs of their people. 

In the past, investing in surgical systems – from equipment to supplies to training more skilled health workers and operating rooms – were thought to be too expensive, too complex or too daunting. However, many essential surgeries are among the most cost-effective health services as highlighted by the World Bank’s Disease Control Priorities, Vol. 3. 

Moreover, as shown by the Lancet Commission on Global Surgery, we now know that reliable surgical infrastructure can strengthen an entire health system, promote economic productivity, and help hospitals weather unexpected shocks like COVID-19.

Unfortunately, in countries where those investments are most needed, progress has been slow.

In 2015, the World Health Assembly (WHA) unanimously passed resolution 68.15 and, for the first time, recognized emergency and essential surgical care and anesthesia as an integral part of universal health coverage. Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) stated that “no country can achieve universal health coverage unless its people have access to safe, timely and affordable surgical services.”

Several countries including Tanzania, Zambia, Pakistan, Ethiopia and others are developing and implementing National Surgical Obstetric and Anesthesia Plans (NSOAPs), national policies for improving a country’s surgical system for the long term, to begin implementing the WHA resolution at the country level.

Despite these meaningful efforts, WHA resolution 68.15 and NSOAPs have yet to transition from policy into action in a meaningful and sustainable manner.

Surgical NGOs, with their direct links to communities and policy makers, are well-positioned to enact these policies. They can and must take a leading position in bringing these plans to fruition.

Working alongside local stakeholders, surgical NGOs will need to expand their services to include infrastructure development for hospitals, increasing research capacity and training local surgical providers. This approach strengthens overall health systems rather than solely focusing on surgeries for a specific patient population.

Some notable examples include KidsOR, which has been able to outfit 25 pediatric operating rooms in 11 countries; LifeBox, which has provided more than 22,000 pulse oximeters to over 100 countries; and Jhpiego, an organization that has trained over 275,000 health care workers globally.

Recognizing the broad social reach that surgical NGOs seek to have, it is important for them to align their services with the health needs and priorities of international governments as outlined in those countries’ NSOAPs.

Operation Smile, a surgical NGO with four decades of experience providing comprehensive cleft care to children around the world, is doing exactly this. Through projects such as the ongoing Global Essential Surgery Project, funded by the UBS Optimus Foundation, Operation Smile is improving surgical systems at hospitals in Nicaragua, Madagascar and Vietnam in collaboration with ministries of health and front-line providers.

To date, the project has trained more than 1,000 health care workers, constructed new operating rooms, implemented safe surgical protocols, trained local biomedical technicians, and engaged local communities so that their residents are aware of conditions that can be treated by surgeries offered at those hospitals.

Early results are promising: Both the number of surgical patients admitted and the number of surgeries provided within the project’s partner hospitals have increased by more than 60% since 2018. More patients are seeking care, and hospitals possess an increased ability to meet this new demand.

Importantly, the evidence generated through this project will help bridge the gap between policy and practice.

Here is our advice for surgical NGOs as they expand their roles towards universal health coverage:

·       Establish equitable partnerships by equipping local health care workers with the knowledge and training necessary to provide care for the long term, drive economic progress and decrease dependency while recognizing that these efforts will take time.

·       Employ a broadened approach that allows for more patients to receive the care they need while simultaneously investing in surgical systems for more ongoing and sustainable care.

·       Expand funding sources by seeking additional avenues of funding. Social impact investors are ready to support sustainable programs that are measurable, repeatable and scalable.

·       Collaboration with other surgical NGOs is critical and must be performed in a transparent manner. Competition will sequester results; collaboration will achieve them

·       Data is vital for establishing evidence needed for scaling up impactful programs and implementing health policies. Improved data tracking processes can be integrated into local and national practices to strengthen information management systems.

·       Partnering with policy makers is paramount. Universal health coverage cannot be achieved without the collaboration of ministries of health.

As we’ve passed the one-year mark since the first cases of COVID-19 and reflect on a pandemic that has so drastically changed our daily lives, we must look onward to how we will repair the flawed health systems and social inequalities that this virus has exposed.

Moving forward, surgical NGOs must act as catalysts that provide activism, partnership and leadership to drive fundamental change – change that ensures universal access to safe, timely and effective surgical care for health that lasts – no matter where you live or how much money you have. 

John Dutton, MD serves as a Global Surgery Fellow at Operation Smile. He is a graduate of Franklin & Marshall College.

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New Social Compact

The Only Wealth, There’s in Man

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The famous quote of Jean Bodinprovide us with an important visualization about the   human capital in developing countries, in order to achieve the millennium development goals.

However, these goals remain challenge that must be realized despite in this epidemiological crisis which created an economic and social threat around the world, it destroyed the pillars of human development such as: education, health and income, so the Index of Human Development has declined to 1,8%.

In fact, the Covid 19 pandemic has put developing countries in a state of emergency to confront this disaster, by strengthening the intangible resources of which human capital is a part.

This article aims to demonstrate the importance of human capital in development process relying on the experience of National Initiative for Human Development, as a pioneer reference that place people at the center of public policies.

The human capital: from conception to process

The concept of human capital is not newly. Yet, it was previously introduced by Adam Smith[1]in his theory. The latter believes «human capital includes the set of skills and abilities that individuals acquired through family education, study and learning. This acquisition result in real expenses that correspond to fixed and integrated capital in the individual which capital is self part of his fortune as the society to which he belongs”.

Furthermore, Adam Smith’s theory was extensively reformulated by economist Gary Beckerin 1964, in his book entitled ‘’Human Capital’’, Becker placed humans at the center of economics and emphasized the important role of investment in human capital, he worked to show that human capital corresponds to all the productive capacities that an individual can acquire through the accumulation of general or specific knowledge and another forms of skills.

The idea raised by Becker reflects the thought of the Greek philosopher Aristotle’s who said : “any one can discover his talents and develop his potential, in the face of the danger of neglecting his humanity and that happiness comes through the realization of the potential of each one ”

These theories devoted to human capital have been developed over the past decades by many international researches and studies as World Bank and The Organisation for Economic Co-operation and Development reports.

According to the World Bank report, Human capital consists of the knowledge, skills, and health that people accumulate throughout their lives, allowing them to realize their potential as productive members of society.

The report point’s out three main components of human capital index as “survival, education, and health”. This indicator was recently created by the World Bank Group as part of the “ Human Capital Project”, so countries can use it as measure productivity for future generation based on what it would be like if this generation benefits from optimal education and health conditions.

In addition, HCI contains three main criteria: the infant mortality rate (rate of survival to age 5), the quality of education (number of school years and quality of education) and health (developmental delay in children and survival rates to adulthood). Otherwise, the combination of these criteria gives a value between 0 and 1, if the index approaches to 1, the country offers good education and health to its citizens, so thus its new generation become more productive, and if the HCI is 0.6, it means that the economic productivity of the younger generation will be 60% of what it could have achieved under optimal education and health conditions, so the country will lose 40% of the economic potential of this generation.

Therefore, without human capital, a nation cannot maintain sustainable economic growth, prepare its workforce for skilled jobs of future the possibility of competition in the globalized economy. Thus, this capital was considered as an interlunar factor of the country’s wealth. Knowing that total wealth consists mainly of intangible capital, add into to produced capital and natural capital.

Consequently, it appears that these human, natural and produced capitals constitute the basic elements of intangible capital. This capital resides in the interaction that takes place between the different types of assets, by adding the tangible assets “ produced capital ”, which are the result of human activity, financial assets, buildings, infrastructure, urban equipment and land, as well as natural assets“natural capital”, such as fossil fuels, minerals, agricultural land, cultivated land, pastures, forests, protected areas, materials raw materials, farmland, forests and protected areas, and human capital.

Moreover, in 1986 the concept of intangible capital appeared by the French specialist in niche markets “ Bruno Bizalion ”, this economist pointed out that the company’s capital also include intangible factors, and then he developed a method which evaluate this intangible potential.

Five years later, the Swedish organization theorist “Leif Edvinsson” used this term in his study of evolution of group management practices. This research was contacted in collaboration with American writer ‘Michæl Malone’, and published in 1997 when they learned about the company hidden wealth, either we say everything you use to create value which one cannot necessarily discover by reading its balance sheet (not all the values of the synergies of the organization are shown). Therefore, intangible capital is related to definition the difference between the real value of the market or the firm and book value.

For the World Bank, the concept of intangible capital is differs from its previous theories. it indicates that the wealth and geopolitical strength of a nation can be built not only with natural resources and built wealth, but also with its capacity for innovation, level of education of its citizens and social cohesion that reigns there.

In its report entitled “Where is the wealth of nations” the World Bank devised a new method of evaluating the wealth of nations, called intangible capital. This capital consists the sum of human capital (all the skills and knowledge available in a country), social capital (the ability of individuals to work together to achieve set goals) and institutional capital (the quality of legal, educational and health systems in place in a country).

As a result, human capital remains an essential element in this process of wealth accumulation and progress which determines earning capacity, and brooding employment horizons of individuals to evaluate the level of income and distribution in the community. Knowthat the development of human capital is not limited to the economic dimensions only, but take in consideration political, social and cultural elements.

The promotion of human capital: A development approach

The promotion of human capital has been a decisive importance in public policies for many developing countries, so there is no strategy or program initiated by the State, local authorities or private sector that mention it.

In this regard, since 1960, Morocco has developed various strategies and programs that fall within the framework of national programs to universal school education and fight illiteracy; social development strategy (SDS) in 1993 to improve social indicators such as education, health and priority equipment; drinking water supply program for the benefits of the rural populations (PAGER) in 1995; social priorities program (BAJ1 ) in 1996 focused on basic education, especially for girls, health care, and employment promotion; rural electrification program (PERG) in 1996; rural development (1997); special decentralized development program (2001).

Nevertheless, these programs and strategies did not succeeded in evolution the level of social indicators in various areas of development. Therefore, the country’s index of human development ranges in position 126.

To remedy this situation, the public authorities have proposed a new approach to struggle poverty and social exclusion in collaboration with the United Nations Development Program.

This approach give significant increase in the gains on consolidation of democracy  in the area of freedom (protection of human rights, public freedoms, justice and gender equality) illustrated by social projects such as the educational reform with education as the second priority after territorial integrity, the entry into force of the Compulsory Health Insurance (AMO) and the measures taken to maintain the continuity of the main pension schemes, the social housing programs have mobilized additional resources, in particularly extra-budgetary, from outside the budget which witnessed new renewed mobilization of all actors involved in the unemployment problem, the national program to support the creation of a business by adapting training to the changing needs of the national productive system and managing  the labor market.

In 2005, these realizations has supported with an innovative strategy named National Initiative for Human Development. This initiative aims to change the social work in the country by opening up a new horizon and an exceptional coherence centred on the development of human capacities.

For 15 years ago, this social project has permitted the realization of countless projects and actions of rising future generations as enhancing health and education services, improving income and economic inclusion of youth people, promoting entrepreneurship & employment, and supporting social & solidarity economy.

In this context, the National Initiative for Human Development has established an arsenal process at the national and territorial level in order to achieve these projects for benefits of society and citizens, to involve panoply of actors present in each territory to participate in the program process, through creation the local, provincial and regional committees which bring together the various stakeholders (local population, associations, regional authorities, experts, and representatives of ministerial departments …). These actors have contributed to implementing within framework of these programs and have taking into consideration issue of citizens’ standard of living at the local level.

These aforementioned mechanisms have been straightened  approve of integrated approach to enhance human capital, to develop new structures named “youth platforms”, this space  considered as forums for interaction between various programs adopted by different stakeholders in the public and private sectors which work for economic inclusion of youth people and rural women by listening, directing them to support and develop their personal skills so that they can bring their ideas and turn them into real projects that constitute sources of local intangible wealth.

In general, this participatory approach demonstrates the importance of human capital as source of wealth creation if it is properly valued.

So, the promotion of human capital has appeared essential in the recent epidemiological crisis,  For that reason, the Moroccan development model must be based on expansion of capacities & freedoms as well as working to stimulate human possibilities & potentialities, taking into account the social and cultural heritage, customs, governance, new information and communication technologies.

To invest in human capital, it is important to promote a systematic foundation for long-term plan that respect the specifics of issues related to education and health, based on the following facts:

– Consolidation of citizenship and human rights (make it possible to release the capacities and potentials of citizens so that they can fully contribute to the achievement of development).

– The importance role of the civil society and its synergy in development process (because development cannot be envisaged without involving civil society).

– Awareness of proximity factor, made on the intangible resource of each territory in order to give an identity or an image for each “city”, each “village” and each “douar”, as taking into the national context in which we operate.

Eventually, the promotion of human capital is not just a goal that must be achieved but rather development approach conditioned on participation and inclusion of human being in this process as an actor regardless of his gender and age.

Bibliography:

  1. Jean Bodin was a French jurist and political philosopher (1529 -1596).
  2. Adam Smith, is a Scottish econimist and  philosopher  (1723-1790).
  3. Adam Smith, The Wealth of Nations, 1776.
  4. Daanoune Rachid and El arfaoui Marouane, ‘’ the concept of intangible capital: the ambiguity of a terminology, Journal of Academic Finance, Vol 9- N ° 1, Spring 2018.
  5. Gary Stanley Becker was an American economist who received the 1992 Nobel Memorial Prize in Economic Sciences.
  6. G. S. Becker, Human Capital, A Theoretical and Empirical Analysis, Columbia University Press for the National Bureau of Economic Research, New York, 1964.
  7. Leif Edvinson et Michæl Malone, Intellectual Capital : Realizing Your Company’s True Value by Finding Its Hidden Brainpower, Collins 1997.
  8. Michael Shawn Malone, Publisher, investor, businessman, author of numerous books on business and high technology such as “The Virtual Corporation”.
  9. Michel Vernières “the notion of human development” in institutions and development seminar, December 2004, p 2.
  10. Rapport mondial sur le développement humain, PNUD 2005.
  11. Resche, Catherine, 2007. «Human Capital : l’avers et le revers d’un texte métaphorique.», LSP and Professional Communication, 7-2 , 23-4.
  12. Sen Amartya,‘’ a new economic model: development, justice, freedom ’, 2nd edition, Odile Jacob, 2003, p 15.
  13. Stéphanie Fraisse-D’olimpio, ’the foundations of human capital theory’, SES-ENS, 2009.
  14. Stiglitz Joseph, Towards a new development paradigm, political economy, 5, 2000, p.5-3
  15. World Bank. 2005. Where is the Wealth of Nations? Measuring Capital for the 21st Century. https://openknowledge.worldbank.org/handle/10986/7505
  16. https://www.banquemondiale.org/fr/publication/human-capital/brief/about-hcp
  17.  http://www.indh.ma/capital-humain/
  18. https://www.undp.org/content/undp/fr/home/news
  19. https://www.cmcmarkets.com/fr-fr/actualites-et-analyses/lindice-de-capital-humain-nouvel-indicateur-de-la-banque-mondiale

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Laws Still Restrict Women’s Economic Opportunities Despite Progress

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Countries are inching toward greater gender equality, but women around the world continue to face laws and regulations that restrict their economic opportunity, with the COVID-19 pandemic creating new challenges to their health, safety, and economic security, a new World Bank report says.   

Reforms to remove obstacles to women’s economic inclusion have been slow in many regions and uneven within them, according to Women, Business and the Law 2021. On average, women have just three-quarters of the legal rights afforded to men.  Women were already at a disadvantage before the pandemic, and government initiatives to buffer some of its effects, while innovative, have been limited in many countries, the report says.

“Women need to be fully included in economies in order to achieve better development outcomes,” said David Malpass, World Bank Group President. “Despite progress in many countries, there have been troubling reversals in a few, including restricting women’s travel without the permission of a male guardian. This pandemic has exacerbated existing inequalities that disadvantage girls and women, including barriers to attend school and maintain jobs. Women are also facing a rise in domestic violence and health and safety challenges. Women should have the same access to finance and the same rights to inheritance as men and must be at the center of our efforts toward an inclusive and resilient recovery from the COVID-19 pandemic.”

Women, Business and the Law 2021 measures the laws and regulations across 8 areas that affect women’s economic opportunities in 190 countries, covering the period from September 2019-October 2020. From the basics of movement in the community to the challenges of working, parenting, and retiring, the data offers objective and measurable benchmarks for global progress toward gender equality. Following the outbreak of the pandemic, this report also looks at government responses to the COVID-19 crisis and how the pandemic has impacted women at work and at home, focusing on childcare, access to justice, and health and safety.

Overall, the report finds that many governments have put in place measures to address some of the impacts of the pandemic on working women. For example, less than a quarter of all economies surveyed in the report legally guaranteed employed parents any time off for childcare before the pandemic. Since then, in light of school closures, nearly an additional 40 economies around the world have introduced leave or benefit policies to help parents with childcare. Even so, these measures are likely insufficient to address the challenges many working mothers already face, or the childcare crisis.

The pandemic has also contributed to a rise in both the severity and frequency of gender-based violence. Preliminary research shows that since early 2020, governments introduced about 120 new measures including hotlines, psychological assistance, and shelters to protect women from violence. Some governments also took steps to provide access to justice in several ways, including declaring family cases urgent during lockdown and allowing remote court proceedings for family matters. However, governments still have room to enact measures and policies aimed at addressing the root causes of this violence.

While it is encouraging that many countries have proactively taken steps to help women navigate the pandemic, it’s clear that more work is needed, especially in improving parental leave and equalizing pay,” said Mari Pangestu, Managing Director of Development Policy and Partnerships, The World Bank. “Countries need to create a legal environment that enhances women’s economic inclusion, so that they can make the best choices for themselves and their families.”

Despite the pandemic, 27 economies in all regions and income groups enacted reforms across all areas and increased good practices in legislation in 45 cases during the year covered, the report found. The greatest number of reforms introduced or amended laws affecting pay and parenthood.

However, parenthood is also the area that leaves the most room for improvement globally. This includes  paid parental leave, whether benefits are administered by the government, and whether the dismissal of pregnant women is prohibited. Reforms are also needed to address the restrictions women face in the type of jobs, tasks, and hours they can work, segregating them into lower paid jobs. And in 100 economies, laws do not mandate that men and women be paid the same for equally valued jobs.

Achieving legal gender equality requires a concerted effort by governments, civil society, and international organizations, among others. But legal and regulatory reforms can serve as an important catalyst to improve the lives of women as well as their families and communities. Better performance in the areas measured by Women, Business and the Law is associated with narrowing the gender gap in development outcomes, higher female labor force participation, lower vulnerable employment, and greater representation of women in national parliaments.

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New Social Compact

Child Abuse & Legal System

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In world where the population is high, crime rate is higher. China has a separate system because China has a large population but the laws are so strict that people are afraid to commit crimes. Legal System of Punishments in China is strict . The recent example in china is during COVID 19. People in China during lockdown was following the laws so strictly. On the other hand the situation in all others countries was very clear.

In countries where the punishments are harsher and deterrent, there is a reduction in crimes. Whereas in countries where the punishments are softer, people do not stop committing crimes.

When we discuss about the Punishments in Islamic Legal System , In Islamic law and the Qur’an there are severe punishments in heinous offenses. In Islam, it has always been the case that if a person commits a major crime, he should be punished in such a way that he becomes a lesson for others and people learn from it.It is in Islam that if someone steals, his hands will be cut off, then no one will ever dare to steal. Prophet Muhammad (Peace be Upon Him) said that if my daughter Fatima also stole, I would cut off her hands.

Legal System of Pakistan , If the punishment is severe then the crime will decrease, if the punishment is not severe then the crime will increase day by day. In our country’s legal system Islamic law exist but No proper implementation is there. We mostly follow the principles of the common law for punishment.

The Pakistan Penal Code deals with punishments in criminal cases. Its origin is from the Indian Penal Code which is dated back to the 1860. When Pakistan came into being they renamed this enactment as Pakistan Panel Code. In fact, the origin of the mentioned punishments in the said enactment have basis from the Common Law System which was the system of British Government in the 19th Century. When  British Government was ruling over the Indo-Pak subcontinent, they made these laws in the beginning.

The Indian Penal Code was the basic legislation made in the 1860. Later on in 1898 the Code of Criminal Procedure was enacted also. Now in India, Pakistan and Bangladesh the same law is the basic criminal law with certain amendments. These laws have been changed a little bit, but their basic laws are the same and it is still implemented to a greater extent.

Example :According to section 377 of Pakistan Penal Code the unnatural offences are defined in a way that they are related to unnatural lust. If a man tries to have sex with a man and even if he tries to have sex with a child, his sentence is 10 years imprisonment. So if an offender wishes to abuse a child with a fear that if he is caught, he will be imprisoned, he will never commit such offense. Similarly if he knows that he will be released in little span of time on bail by getting the consent from the child’s family and by settling the matter by giving them some money, he may commit the offense without any fear. He may commit the same offense again and again.

Conclusion:It is important to create deterrence in punishments especially in heinous offenses so that people have fear of committing them. Only this way offenses can be controlled and society can be peaceful to live in.

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