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.
KP’s Education Reforms – Heading Towards Right Path
The first word revealed in the holy Quran was “Iqra” which means “to read”. This first verse of Holy Quran shows us the importance of pen, greatness of knowledge and importance of education in Islam. Article 25-A of Pakistan’s constitution obliges the state to provide free and compulsory education to all children between the ages of five and sixteen. Education is the reason behind rise and fall of any nation. After the 18th amendment, on April 19th 2010, the education sector was assigned to the provinces, with a hope that provinces would focus on providing quality education, as previously; there was a lack of comprehensive planning and strategy in this sector.
During its second stint in KP, PTI-led government declared an education emergency in the province. As part of election manifesto, PM Imran Khan reiterated his firm resolve to upgrade education system across KP. Consequently, during past three years, KP government has focused on the neglected education sector and introduced various revolutionary steps to improve the quality of education.
The provincial government is spending heavily on building infrastructure and basic facilities. The number of non-functional schools have been reduced massively due to effective policies. A real time focus is given to the lack of facilities like boundary walls, water supply, electricity, and toilets. To get rid of load shedding issues, the government installed thousands of solar panels in schools to have an un-interrupted supply of electricity at daytime. Simultaneously, increased annual budget for education.
The present age is known as an era of Information Technology (IT) and a nation cannot progress without making full use of it. Therefore, the provincial government has established thousands of state of the art IT labs across KP. It is pertinent to mention here that Microsoft has also endorsed this effort and offered to train above 15000 IT teachers with free certification.
The major five-year revolutionary educational reform plan (2019-2023) was brought by department of Elementary and Secondary Education as a flagship project of KP government in this tenure. The four core aspects of this innovative plan includes teachers’ training, curriculum reforms, establishment and up-gradation of schools and the appointment of new teaching staff.
In order to reduce teacher to student ratio it has been decided to hire 65,000 new teachers well versed with modern education techniques, including 11,000 primary teachers under this five years’ plan. So far, more than 40,000 teachers have been recruited on merit bases through NTS. After the merger of tribal districts in KP, the education Ministry has approved a handsome amount for the restructuring the current education system. In order to modernize the current education system, KP government has established 138 Data Collection Monitoring Assistants (DCMAs) in tribal districts.
Taleemi Islahi Jirga (TIJs) are converted into Parent-Teacher Councils (PTCs) and connected them with education ministry with an aim to keep a check and balance. Government has introduced a new concept of school leaders and aims to train about 3,000 leaders who will be responsible for monitoring the classrooms, lesson management, implementation, and daily school life.
The process of expanding teachers’ training program to all districts of the province is also in process. Furthermore, the education department has almost completed its working on the development of high-quality script lessons for different subjects. Textbooks for classes 1 to 10, will also be revised according to modern standards by 2023.
Another milestone achieved by KP government is the establishment of Independent Monitoring Unit (IMU). This vigilant monitoring system has reduced teachers’ absenteeism by 17% to 20%. It also constantly collects reliable data which is helpful for realistic planning.
Previously, teachers used to take salaries without performing any duties; however, with the advent of biometric attendance system, those ghost servants have been captured. Enrollment drives have been organized every year. Government is giving free books to the children including drawing and coloring books to enhance their creative thinking. Government is also stressing on female education through its new policy of building classrooms with a ratio of 2 for female and 1 for male.
To impart the true teachings of Islam, Quranic education and Nazira is made compulsory up to class 12th. In a refreshing development, students of private schools are migrating to government schools due to student-friendly policies.
Nevertheless, there is room for improvement in the education sector like linking promotions of teaching and administrative staff with performance. Government teachers should be made bound to enroll their children in public sector. The concept of uniform curriculum will create national thinking. Another important aspect which needs attention is to address the growing role of tuition and coaching centers. Technical education should also be focused from the base. Experiences of others successful educational models like Finland model may be studied to improve the sector.
Eurasian Forum: Empowering Women in the Changing World
Women play an increasingly important role in resolving issues that society and the state encounter and in the modern world, they should not face the choice between family and self-fulfillment, Russian President Vladimir Putin said at the third Eurasian Women’s Forum held in St. Petersburg on October 13-15.
“It is completely obvious that in modern conditions a woman should not face the choice between children and family or professional fulfillment. That is why in Russia the conditions are consistently created for a woman after childbirth to begin or resume her professional career at any moment, to become accomplished, to achieve growth in what she enjoys,” Putin stressed.
The Eurasian Women’s Forum, held since 2015, is one of the largest international platforms uniting female leaders from all continents to examine and discuss the role of women in the modern world and work out new approaches to solving global problems.
The forum was organized by the Federation Council of the Federal Assembly of the Russian Federation and Interparliamentary Assembly of the Commonwealth of Independent States (IPA CIS). This forum has won wide recognition as an effective mechanism of interaction and dialogue for women who are influencing social, political and economic decisions. It facilitates the growing participation of women’s movements in resolving global challenges.
The chosen theme of the third forum “Women: A Global Mission in a New Reality” has much significance for today’s world. Boosting international cooperation to enhance the role of women in order to meet the goals of sustainable development, forming women’s agenda and new approaches to solving global problems in the new reality – these are the main objectives for participants and organizers.
The participants, indeed, devoted key debates to the role of women in ensuring global security, the transition to new models of economic growth and social progress, overcoming the adverse consequences of the coronavirus pandemic, developing healthcare, balancing universal digitization, and addressing global environmental and climate problems.
For the first time, the forum feature meeting of the International Working Group of the Organization for Economic Co-operation and Development’s Nuclear Energy Agency on improving gender balance in the nuclear energy industry.
Expert sessions featured prominently for international organizations and associations. Those include field sessions of Women 20, the UN session on industrial development (UNIDO), the World Bank session, the BRICS Women’s Business Alliance meeting, international club of APEC BEST AWARD winners and participants, and International Club of Women Regional Leaders.
Throughout the world, there is a growing demand for female leadership. Research has shown that companies with women on their boards of directors enjoy better results. As new skills requirements are emerging, so educational programmes for female leaders are becoming critical. The ability to share experience at an international level of implementing such programmes help foster joint initiatives. This shows a turn for women in political sphere.
In the face of global challenges, there is an increasing need for a new paradigm, along with a renewed focus on changing attitudes to women. Women have made an enormous contribution to efforts to improve health, raise life expectancy, and improve quality of life. These are the first role as women in the family, and this is unchangeable fact in the world.
Previously there had been some innovations. The BRICS Women’s Business Alliance was first presented at the 2nd Eurasian Women’s Forum. The leaders of Brazil, India, China, Russia, and South Africa gave their unanimous support to the initiative, and adopted the declaration on the establishment of the alliance. Last year (2020) saw the official launch of the BRICS Women’s Business Alliance.
The alliance seeks to implement multilateral cooperation projects aimed at consolidating and strengthening its role in the global economic agenda. The alliance’s areas of focus include the development of innovation, healthcare, food and environmental security, an inclusive economy, the creative industries, and tourism.
Women have been forging alliances and ahead of this forum for instance, the Women’s Business Association of the Federation of Indian Chambers of Commerce and Industry (FLO FICCI), considered as the largest women’s business association in India, signed a memorandum of understanding with Russia. This collaboration aims at developing women’s entrepreneurship, social communications and at creating favourable conditions for cooperation between business circles in Russia and India.
It plans promoting entrepreneurship and professional excellence through seminars, conferences, lectures, trainings, and other events aimed at encouraging and stimulating the involvement of the skills, experience, and energy of women in all sectors and at all levels of economic activity.
The Eurasian Women Association has so many programmes and projects with other women’s groups and associations in the Eurasian region, in Asia, Africa, and Europe. Obviously, women have come a long way throughout the world, since their first conference held 1986 in Beijing, China and resultantly declared March 8 – as International Women’s Day marks annually throughout the world. Women have taken up the fight, sometimes collaborating with women-conscious men and thus paving the way up to the top echelon in all economic and social spheres. Women now have a structured organization from the grassroots, in all countries, and up to regional organizations and to the United Nations.
Speaker of the Federation Council, Valentina Matviyenko, in her opening speech at the plenary session, highly stressed that the main goals of the global women’s community as that directed towards improving people’s quality of life as well as building mutual understanding and trust between countries and peoples in the name of peace and sustainable development.
Russian Deputy Prime Minister, Viktoria Abramchenko, similarly noted in her speech that women are directly involved in implementing broad scope of development tasks in Russia and beyond on international platforms.
Vietnamese Vice President, Vo Thi Anh Xuan, made a video conference presentation. She said that the forum is bringing together the majority of women around the world. “The role of women today is extremely important. We can make the world more just and help fight global challenges,” she said.
Chairwoman of the National Assembly of Azerbaijan Sahiba Ali gizi Gafarova believes that the topics discussed at the Eurasian Women’s Forum provide an opportunity to consider the most pressing issues of modern life and enhance women’s status around the world. Gafarova unreservedly stated that fully unleashing women’s potential would be the foundation for building a healthy society.
Chairwoman of the Senate of Uzbekistan Tanzila Narbaeva noted that the forum once again demonstrated women’s growing role in resolving the socioeconomic issues facing their countries, and demonstrates new approaches to the women’s agenda.
Narbaeva stressed that Uzbekistan, for instance, is ready to share its experience in various areas and is open for multifaceted cooperation. She invited the participants to take part in the women’s forum during the Shanghai Cooperation Organization summit in 2022, planned in Samarkand, the second largest city in Uzbekistan.
Chairwoman of the Lower Chamber of Parliament of Turkmenistan, Gulshat Mammedova, said the forum is an important platform for interaction between women and helps to harmonize efforts in addressing various issues of our time as well as exchange views and experience in promoting women’s rights.
Participation of African women was modest, that included for example President of the Senate of Gabon Lucie Milebou Aubusson, Liberian Dr. Jewel Howard-Taylor and Zimbabwean First Lady Auxillia Mnangagwa among a few others. President of the Assembly of Mozambique, Esperança Laurinda Francisco Nhiuane Bias, delivered a speech at the forum.
Zimbabwean First Lady, Auxillia Mnangagwa, on the sidelines held a special working discussion with the Speaker of the Federation Council of the Federal Assembly of the Russian Federation, Valentina Matviyenko, focusing on developing inter-parliamentary relations, women in sustainable development, education and charity.
The First Lady and the Speaker snapshotted on the possibility of greater participation of Russian economic operators in the development process in southern African region. Both women have expressed an appreciation cooperating on various questions on international platforms. Diplomatic relations between the two marked its 40th year.
On October 15, the participating African women took part an exclusive discussion solely on “the Role of Women in the Integrated Development of the African Continent” at the Tauride Palace. It was attended by women from international organizations, business circles, scientific or academic community and non-governmental organizations.
The entire third forum, organized primarily to review how women have performed in men-dominated world, identify challenges and roadblocks on their way to gender equality and fight for higher social status and, of course, outline new strategic goals for the future. It was held offline using modern formats such as video conferencing and online broadcast, intended to ensure extended outreach and provide audience engagement. The rules and regulations for physical presence was in strict accordance with safety measures aimed at preventing the spread of COVID-19.
Inequalities between ethnic groups are stark -UN report
Differences in so-called multidimensional poverty among ethnic groups are consistently high across many countries, according to a new analysis released this Thursday.
The global Multidimensional Poverty Index (MPI), produced by the UN Development Programme (UNDP) and the Oxford Poverty and Human Development Initiative, also found that in nine specific ethnic groups surveyed, more than 90 per cent of the population is trapped in poverty.
In some cases, disparities across ethnic and racial groups are greater than across regions within a country. More than that, the disparities across the Index for ethnicity, is greater than that across all 109 countries, and all other variables tested.
Besides income, the Index measures poverty using various indicators, including poor health, insufficient education and a low standard of living.
The research for the report was conducted across 109 countries, covering 5.9 billion people, and presents an ethnicity/race/caste disaggregation, for 41 nations.
Within a country, multidimensional poverty among different ethnic groups can vary immensely.
For example, in Latin America, indigenous peoples are among the poorest. In Bolivia, indigenous communities account for about 44 per cent of the population, but represent 75 per cent of multidimensionally poor people.
The figures are also stark in India, where five out of six people in this situation were from “lower tribes or castes”, according to UNDP.
Proposing solutions for this problem, the authors point out the example of the two poorest ethnic groups in Gambia, that have roughly the same value in the Index, but have different deprivations, to show that different policy actions are needed to find effective solutions for different cases.
Focusing on gender, the report shows that, worldwide, about two-thirds of multidimensionally poor people, or 836 million, live in households where no woman or girl has completed at least six years of schooling.
Besides that, one-sixth of all people in this situation, about 215 million, live in households in which at least one boy or man has completed six or more years of schooling, but no girl or woman has.
The report also finds that these women and girls are at higher risk of suffering intimate partner violence.
Across the 109 countries studied, a total of 1.3 billion people are multidimensionally poor.
About half of them, 644 million, are children under age 18; and nearly 85 percent live in Sub-Saharan Africa or South Asia. More than 67 percent live in middle-income countries.
Living in multidimensionally poverty can mean very different things.
Around 1 billion people, for example, are exposed to health risks due to solid cooking fuels, another billion live with inadequate sanitation, and another billion have substandard housing.
Around 788 million live in a household with at least one undernourished person, and about 568 million lack improved drinking water within a 30-minute roundtrip walk.
For UNDP Administrator, Achim Steiner, this is a reminder “of the need for a complete picture of how people are being affected by poverty, who they are and where they live.”
Mr. Steiner also highlighted the COVID-19 pandemic factor, saying the international community is “still grappling to understand its full impacts.”
Even though multidimensional poverty remains high, there were signs of progress in some countries, at least until the beginning of the pandemic.
Of the 80 nations and five billion people for which there is data over time, 70 reduced their Multidimensional Poverty Index in at least one period. The fastest changes happened in Sierra Leone and Togo.
The director of OPHI at the University of Oxford, Sabina Alkire, stressed the need to fix the structural inequalities that oppress and hinder progress.
For her, disaggregating multidimensional poverty data by ethnicity, race, caste and gender “unmasks disparities and forms a vital guide to policymakers to leave no one behind in the last decade for action.”
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