31 August 2012

Development Down Under: On the Up

I just got back from an interesting trip to Australia. There’s lots going on: Brisbane is the host for the 2014 G20 meeting; Prime Minister Julia Gillard has been appointed chair of the MDG Advocacy Group and is currently at the Pacific Island Forum with Hillary Clinton and Michelle Bachelet, promoting women’s empowerment; Australia is applying for UN Security Council membership and the speed at which the Government’s commitment to get ODA to 0.5% of GNI is the subject of much political debate in Canberra and beyond.

I made 3 presentations while I was there: on post-2015 options (at AusAID), on the role of ODA in reducing malnutrition (at the Development Policy Centre at the Crawford School at ANU), and on undernutrition in Indonesia (at AusAID). I also participated in a roundtable at the Lowy Institute on the future of development and met with representatives of the Australian equivalent of BOND, ACFID (Australian Council for International Development).

Starting with the last presentation--stunting in Indonesia is stuck. It was about 42% in 2000 and 40% in 2007. At this rate it will halve its 1990 rate by 2052, rather than by 2015. Because it is such a large country, this means about 10 million Indonesian children are stunted, or about 1 in 16 world-wide. I can’t pretend to know why stunting rates are stuck. Poverty rates have been declining steadily and at a good pace. Economic growth has not been spectacular, but solid. Inequality is relatively high and static. Social protection programmes are being implemented, but with little effect so far on stunting. Agricultural productivity growth is lower than anywhere in the region, although agriculture spending has increased of late. Direct nutrition intervention coverage is low. The potential for stunting reduction to be accelerated seems high, but where is the leadership to address it within and outside of Indonesia? The situation is even worse in East Timor, with stunting rates nearer 60%, some of the highest in the world. Here, capacity is a critical constraint, although the issue is not seen as an economic development one. See powerpoints here.

On ODA to nutrition, I summarised the case for public policy intervention in nutrition (externalities—intergenerational transmission and chronic disease later in life; information asymmetries—the invisibility of stunting; and missing markets--the inability to borrow income to buy nutrition inputs to help infants through their first 2 years of life). I ran through the case for ODA related to nutrition (moral—saving lives, innovation in programming perceived of as too risky for governments; facilitating learning from experience from around the world, and supporting participation and resource mobilisation via opportunities such as the Scaling Up Nutrition movement). We talked about the difficulty of tracking ODA in nutrition and the barriers perceived by donors to their own scaling up of activity (too complicated to work across sectors, need to recruit lots of new nutrition skills, the paradox of needing to be demand led but acknowledging that the invisibility of undernutrition leads to low demand). See powerpoints here.

Finally, on post-2015 fever. I summarised the key contrasts between the pre MDG period and now; the evidence on whether the MDGs made a difference, the various proposals (MDG+, MDG 2.0, SDGs, Hybrids, and Global Development Goals) and potential scenarios. My key points were: (a) the most fundamental question--what kind of development do we want?—is rarely addressed, (b) the competing interests and how they play out in the political contexts at the national and international levels are rarely made explicit, (c) most of the proposals are lists, with no underlying theory of change about how we get the development we want and (d) the lack of leadership for delivering the post 2015 goals--in many ways, 2015 has come too early. Instead we get list-o-mania with lots of second order questions serving as distractions (what targets and indicators, what time period, which countries, how many etc.). The questions are important, but they need to follow from answers to questions about the kind of development we want (poverty focused, global public goods focused, sustainable development focused etc.). Form needs to follow function. As usual I am completely shameless in giving my two cents worth on the opportunities for the Australian government in all these areas. See powerpoints here.

All in all a really interesting set of meetings: lots of very knowledgeable people and lots of interesting differences from the European scene (e.g. AusAID being one of two rich countries in its regional sphere of 24 countries; fascinating AusAID work on disability; the extreme poverty on its doorstep in Timor Leste; no development research associations, but a vibrant and rapidly growing development research scene).

And I saw a Brushtail Possum....

13 August 2012

London 2012's Legacy Should be "No More Stunting" by the 2032 Games

So, the Olympic Hunger Event has come and gone. David Cameron resisted doing Mo Farrah's Mobot (a wise move) and, no doubt well-briefed, he also resisted the temptation to simplify the challenge of eradicating childhood stunting (another wise move).

The Event generated £120m (additional?) in commitments from the UK to fighting stunting in 3 areas: (a) getting agriculture to do more to reduce stunting, (b) getting the private sector to be more pro-nutrition and (c) doing a better job of tracking undernutrition -- and the commitment to fighting it.
More importantly the Event gave some shape, definition and purpose to the UK’s G8 meeting next year and simultaneous Irish leadership of the EU.

It is too early to tell if the Event was a success. From those who were there, it is clear that the right commitments were made by a range of governments and companies (it wasn’t only the food and pharmaceuticals that were present). The Event certainly avoided calamity, which is quite an achievement--it was a bold move to hold a summit on a very serious topic just before a big party to celebrate the end of a terrific Games. David Cameron did not have to do it, and he did, so kudos to him and Andrew Mitchell.

Of course making commitments when you have a bunch of people breathing down your neck is the easy part. The hard part is sticking to the commitments. Just as hard is monitoring who is sticking to them. It’s like athletes making predictions about winning a race and then no-body being able to watch the race first hand and relying on the athlete’s own accounts. That’s why I am so keen on the new tools for monitoring commitment—it’s the equivalent of “super slo-mo”.

It’s a shame that the media had to have their Olympic celebrities there to make the Event more newsworthy, but that is not “super fast Mo” and the other Olympians’ fault. Readers’ online comments on the news stories were not too dispiriting either—even if there were a few along the lines of “why are these celebrities putting their hands in the British taxpayer pockets when we have so many problems at home?” Whoever wrote that has never seen how malnutrition eviscerates a child’s life.

What about the targets on stunting? In May 2012 the World Health Assembly (convened by WHO) agreed to a new target of reducing the number of stunted children by 40% (about 70 million) by 2025. This is 13 years away, so means about 5-6 million a year, hence the announcement at the Event of efforts to prevent another 25 million kids being stunted by the next Olympics in 4 years time in Rio.

I think these targets are good—but are too timid. We can eradicate stunting within 20 years—we know what to do, we know how much it will cost each year (for the direct nutrition interventions the annual budget is about what the London 2012 Games cost--£9 billion)—all that is missing is the political commitment, hence the need for the commitment “super slo-mo”.

As a Londoner, I was proud of the Games (I grew up about 5 miles from the Olympic Stadium). But the Games are a confection in a world where the main children’s course –food, health and care-- is often absent.

I will be truly proud of London 2012 if it moves us faster to a world of no stunting at the 35th Olympiad in 2032.

11 August 2012

Why is Stunting Rising in Pakistan and what to do about it?

Call for Abstracts for IDS Bulletin on Accelerating Undernutrition Reduction in Pakistan

Lawrence Haddad, Institue of Development Studies, Sussex
Zulfiqar Bhutta, Aga Khan University, Karachi
Haris Gazdar, Collective for Social Science Research, Karachi

Pakistan recently released the results of the 2010-11 National Nutrition Survey.  This was the first national nutrition survey for 10 years. The 2001 survey estimated stunting of under 5’s at 41.5%.  This is slightly lower than the rates in India, but is still higher that most countries in sub-Saharan Africa.  Trend data are confused. The WHO Global Database on Child Growth and Development report the following trend on national surveys for stunting rates: 70.5% in 1977; 62.5% in 1985-87; 42.7% in 1990-94; 54.5% in1990-91; and 41.5% in 2001.  But there is no confusion about the recent past.  The 2010-11 survey tells us that stunting rates have risen in the past decade to 43.7%. 

Over the past 10 years, Pakistan’s economy has not grown as rapidly as India’s, moreover it has been affected by instability, unrest, floods, and general fragility. It is perhaps not surprising that Pakistan has not managed to reduce undernutrition in that context. Given the rates have increased, then we need to understand which regions and groups have fared the worst, and understand the ways in which undernutrition reduction efforts need to scale up, how different sectors need to contribute, the institutional arrangements that can underpin such efforts and how the political commitment can be built up to prioritise, sustain and evaluate these efforts. 

In the context of an IDS Bulletin, we aim to bring together a range of analysts, activists and policymakers from Pakistan to help raise the profile of nutrition within Pakistan and to identify actions that can be taken by various stakeholders to accelerate undernutrition reduction.  

The Call

We are inviting abstracts of up to 300 words for 12-16 short research and policy papers (3000-4000 words) on any of the following themes (please tell us which one of these questions your abstract addresses).
  1. The determinants of the increase in stunting in Pakistan
  2. The interventions and approaches that work in Pakistan, and why and how they do
  3. What can be done to raise the profile of nutrition within the Pakistan development agenda
  4. The policy and evidence priorities

We are particularly interested in submissions from those working in Pakistan. 

The deadline for submission of abstracts is September 15.  We will not consider any abstracts received after this date. 

Please send your abstracts to Lawrence Haddad at L.haddad@ids.ac.uk

The editors will select abstracts and invite authors to write full articles.    The editors will have the paper peer reviewed, with written comments supplied to authors on how to strengthen their papers.  Some papers might have to be dropped at this stage.   The final set of papers will be copyedited and typeset.   An overview paper will be prepared by the editors. A small honorarium will be given to successful authors. 

The IDS Bulletin will be published in May 2013 and launched in Pakistan and London. It is supported by UKAID. 

Please pass this call on to colleagues who you think might be interested in participating.  

02 August 2012

Prioritising Pleasure: A Path to Safer Sex?

No, this blog is not a blatant attempt to increase my page views. It is about a new report produced for last week’s HIV/AIDS Conference in Washington DC: Everything You Wanted to Know About Pleasurable Safer Sex But Were Afraid to Ask.

It is produced by Wendy Knerr and Anne Philpott of the Pleasure Project for the IDS Sexuality and Development research programme.

The report is a literature review which asks a number of questions about the motivations for safer sex and the role that pleasure seeking plays in those motivations. It takes as its starting point the fact that much of the research on what influences whether safer sex is or is not practised comes down to safer sex being perceived as less pleasurable.

The report is a difficult one to read on a plane (which is where I wrote this blog) because it contains provocative (for a research review anyway!) pictures (yes, there is an erect penis in a condom). It is structured around 20 big questions (think Foreign Policy’s "Sex Issue", but without the sexual repression) all of which are researched through online searches of the standard peer reviewed and grey literature databases.

The report is provocative for all the right reasons. It asks the question: if a lack of pleasure is one reason given for the non-practise of safer sex, can we make safer sex more pleasurable? Can it be eroticised either through framing, depiction or practise? If it can, will this lead to more positive attitudes towards safer sex, and therefore to the increased practise of safer sex?

Given the vast numbers of disability adjusted life years (DALYS) that sexual and reproductive health diseases still account for, finding ways of turning pleasure from a barrier to safer sex into an enabler seems sensible. The interventions need not be expensive and could lead to very quickly scaled up behaviour change, generating very large benefit-cost ratios (sorry, couldn’t help but bring that in).

The report concludes that we need more research at the intervention level, especially in countries with high burdens of HIV where evidence is scarcest.

Given the ease with which the topic can be (unfairly) dismissed, I would have liked the search and select protocols to have been ratified and even more transparent (was there a quality grading?) but for a non-systematic review the authors have given an admirably clear guide as to how they went about their review.

Pleasure is a driver of much human behaviour. Economists tend to use the unlovely term “utility” to describe some combination of satiation, satisfaction and pleasure, but as the newly discovered world of behavioural economics begins to be more and more influential, perhaps the role of pleasure will be explored in the world of financial transactions. 

(It could give a whole new meaning to Freakonomics.)