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We analyze the costs and benefits of "Community-Led Total Sanitation" (CLTS), a sanitation intervention that relies on community-level behavioral change, in a hypothetical rural region in Sub-Saharan Africa with 200 villages and 100,000 people. The analysis incorporates data on the effectiveness of CLTS from recent randomized control trials (RCTs) and other evaluations. We value reduced mortality benefits by adjusting estimates for the value of statistical life (VSL) from high income countries to reflect incomes in Sub-Saharan Africa. Reduced morbidity benefits are calculated using a cost of illness (COI) approach based on recent studies quantifying the cost of diarrheal disease in Sub-Saharan Africa. Time savings from owning a latrine are valued using estimates for the shadow value of time based on a proportion of the average local wage. Costs include the cost of intervention implementation and management, households' time costs for participating in the community behavioral change activities, and the cost of constructing latrines. We estimate the net benefits of this intervention both with and without the inclusion of a positive health externality, which is the additional reduction in diarrhea for an individual when a sufficient proportion of other individuals in the community construct and use latrines and thereby decrease the overall load of waterborne pathogens and fecal bacteria in the environment. We examine the sensitivity of the results to changes in the effectiveness of the CLTS intervention. A probabilistic sensitivity analysis using Monte Carlo simulation is used to examine the sensitivity of the results to changes in all of the parameters in the benefit-cost model. We find that CLTS interventions would pass a benefit-cost test in many situations, but that benefit-cost metrics are not as favorable as many previous studies suggest. The model results are sensitive to baseline conditions, including the income level used to calculate the VSL, the discount rate, and the time spent traveling to defecation sites. We conclude that many communities will have economic investment opportunities that are more attractive than CLTS, and recommend careful economic analysis of CLTS in specific locations.
Water quality testing is critical for guiding water safety management and ensuring public health. In many settings, however, water suppliers and surveillance agencies do not meet regulatory requirements fortesting frequencies. This study examines the conditions that promote successful water quality monitoring inAfrica, with the goal of providing evidence for strengthening regulated water quality testing programs. Methods andfindings:We compared monitoring programs among 26 regulated water suppliers and surveillanceagencies across six African countries. These institutions submitted monthly water quality testing results over 18 months. We also collected qualitative data on the conditions that influenced testing performance via approximately 821 h of semi-structured interviews and observations. Based on our qualitative data, we developed the Water Capacity Rating Diagnostic (WaterCaRD) to establish a scoring framework for evaluating the effects of thefollowing conditions on testing performance:accountability, staffing, program structure, finances, andequipment & services. We summarized the qualitative data into case studies for each of the 26 institutions and then used the case studies to score the institutions against the conditions captured in WaterCaRD. Subsequently, we appliedfuzzy-set Qualitative Comparative Analysis (fsQCA) to compare these scores against performance outcomes forwater quality testing. We defined the performance outcomes as the proportion of testing Targets Achieved (outcome 1) and Testing Consistency (outcome 2) based on the monthly number of microbial water quality tests conducted by each institution. Our analysis identified motivation & leadership, knowledge, staff retention, and transport as institutional conditions that were necessary for achieving monitoring targets. In addition, equipment, procurement, infrastructure, and enforcement contributed to the pathways that resulted in strong monitoring performance.
Global Handwashing Partnership;
In this summary, we outline key themes and findings from 117 handwashing-related research papers published in 2017. This summary presents the overarching findings of the literature on handwashing, and explores specific data and context. Key themes include access and coverage; benefits of handwashing; measuring handwashing compliance; handwashing behavior change; drivers of handwashing; and efficacy of handwashing hardware including various types of soaps and rubs.
Increased use of (relatively abundant) land, rather than improved technical efficiency, has been the main driver of agricultural production growth in Africa south of the Sahara (SSA) over the past five decades. However, rapid population growth and the adverse effects of climate change are increasingly putting pressure on land availability, land fertility, and water access. Given the well-documented positive impact of agricultural research investment on agricultural productivity growth, it is critical that African countries step up their investment in agricultural research and instate sound policies to promote technological and institutional innovations in the agricultural sector.
This report assesses trends in investments, human resource capacity, and outputs in agricultural research in SSA. It highlights the cross-cutting trends and challenges that emerged from ASTI's country-level data, structuring it within four broad areas: funding capacity, human resource capacity, research outputs, and institutional conditions.
Key findings of the report include:
Agricultural research spending in SSA grew by nearly 50 percent between 2000 and 2014. However, underinvestment remains widespread, with 33 out of 40 countries for which data were available spending less than 1.0 percent of their AgGDP on agricultural research.
Across SSA, agricultural researcher numbers increased by 70 percent during 2000–2014. However, a very large share of senior PhD-qualified researchers are approaching retirement. Without adequate succession strategies and training, significant knowledge gaps will emerge.
Female scientists remain grossly underrepresented in agricultural research, despite the fact that they are in a unique position to effectively address the pressing challenges facing African farmers, the majority of whom are female.
Donor dependency and funding volatility remain critical in a large number of African countries.
Outdated research facilities and equipment are impeding the conduct of productive research, which compromises the number and quality of research outputs and ultimately translates into reduced impact.
The report concludes by outlining a number of policy measures that SSA governments can undertake to address the various challenges related to agricultural research funding, human capacity, outputs, infrastructure, and institutional structure.
A new report from UNICEF - 'A Deadly Journey for Children: The Central Mediterranean Migrant Route' - provides an in-depth look at the extreme risks facing refugee and migrant children as they make the perilous journey from sub-Saharan Africa into Libya and across the sea to Italy. Three quarters of the refugee and migrant children interviewed as part of a survey said they had experienced violence, harassment or aggression at the hands of adults at some point over the course of their journey, while nearly half of the women and children interviewed reported sexual abuse during migration – often multiple times and in multiple locations.
Last year, at least 4,579 people died attempting to cross the Mediterranean from Libya, or 1 in every 40 of those who made the attempt. It is estimated that at least 700 of those who lost their lives were children.
UNICEF is urging governments to adopt their 6-point agenda for action, designed to keep child migrants safe.
The Tackling FGM Initiative (TFGMI) has been working since 2010 to strengthen the prevention of Female Genital Mutilation (FGM) at community level. There were two phases of the TFGMI – Phase One from 2010-2013, and Phase Two from 2013-2016. Over the course of both phases, 51 organisations were funded with a total of £2.8 million invested. This evaluation report focuses on results achieved in Phase Two.
Phase One of the Initiative produced a clearer understanding of 'what works' for community-based prevention of FGM in the UK context. This included working with women affected by FGM as 'community champions' to amplify the voice of survivors and people from affected communities, religious leaders and young people, and raising awareness of the health, and other harms of FGM, as well as the UK law. Gaps identified at the end of Phase One included the need to: strengthen rights-based approaches to ending FGM; further access isolated communities; enhance comprehensive responses to FGM by strengthening relationships with statutory agencies.
In addition, within the TFGMI a small grants programme was initiated with funding from Comic Relief. This aimed to widen the impact of the TFGMI into further geographic areas, building on what had been learnt under Phase One.
Overview of Programme Aims and Objectives:
Both the Tackling FGM Initiative small and large grants programmes aimed to achieve the overall aims which were;
- To strengthen community-based preventive work to protect the rights of women and children
- To reduce the risk to girls and young women in the UK of under-going genital mutilation in all its forms
The objectives of the TFGMI Large Grants Programme for Phase Two were:
1. To strengthen work which promotes a rights-based approach to tackling FGM among affected communities.
2. To undertake awareness-raising work with target audiences using the most effective messages for that group.
3. To reach those who are most resistant to work which tackles FGM or those who don't normally access services or engage in community activities.
4. To increase the skills and capacities within affected communities to speak out against FGM.
5. To strengthen the capacity of community groups to engage with statutory agencies so that prevention of FGM among women and girls at risk in the UK is mainstreamed as a form of child abuse and violence against women.
6. To strengthen the network of groups active in tackling FGM and work with policy-makers and partners locally contributing to a broader campaign to end FGM in the UK.
The small grants programme had an additional four objectives, but these were subsumed into large grant objectives due to their similarities:
- Activist groups become more confident, more knowledgeable, and more skilled in championing issues within their communities (Objective 4 of the large grants programme).
- Grassroots organisations and activist groups become more skilled in engaging with, and in lobbying the range of relevant statutory bodies for appropriate responses to the issue (Objective 5 of the large grants programme).
- A more cohesive, more unified movement that embraces a range of stakeholders (small and larger groups) sharing learning and good practice in addressing this issue. (Objective 6 of the large grants programme).
1. In addition, a specific aim of the small grants programme was to "reach more communities in more geographical areas and that more sections of these communities are reached, increasing the movement to stamp out FGM in the UK.'
Oxfam analysis reveals that 51 of the 68 companies that were lent money by the World Bank's private lending arm in 2015 to finance investments in sub-Saharan Africa use tax havens. Together these companies, whose use of tax havens has no apparent link to their core business, received 84 percent of the International Finance Corporation's investments in the region last year. As the World Bank and IMF prepare for their Spring Meeting in Washington 13-15 April, and in the wake of the Panama Papers scandal which reveals how powerful individuals and companies are using tax havens to hide wealth and dodge taxes, Oxfam is calling on the World Bank Group to put safeguards in place to ensure that its clients can prove they are paying their fair share of tax.
William and Flora Hewlett Foundation;
This paper describes the Global Development and Population Program's sub-strategy for strengthening the quality and effectiveness of advocacy by locally-based, indigenous groups targeting national or sub-national family planning and reproductive health decision-makers.
In 2011, the Conrad N. Hilton Foundation launched what has become a remarkably successful strategic initiative to protect, promote and support the development of youngchildren affected by HIV and AIDS. Highlights of the Initiative include the Foundation's leadership and leverage, opening up a new area and generating international and nationalinterest in the work; the partnerships it has established with many of the largest and most experienced implementers of programs for children and communities affected by HIV andAIDS in sub-Saharan Africa; the large numbers of children and families who have been supported through the activities of partners and collaborating community-based organizations and local government services; the unique learning networkcreated among researchers, implementers, policy makers and community groups; the growing awareness in the sub-Saharan African region of the importance of supportingfamilies during the earliest years of a child's life; improved implementation and accountability through joint work on logic models and measurement tools, and innovation in assessment, practice, and advocacy.
In the three years that we have monitored the Foundation's Children Affected by HIV and AIDS (CABA) Initiative, 320,549 children have been provided with one or more services (seeFigure 5), as have 177,754 parents or caregivers. A third of children (119,180) attended partner-supported community-based child care centers. Nearly three hundred thousand (277,054) home visits were made to approximately 54,000 households and more than 37,000 professionals, community and government workers received some form of training.
There is a lot to celebrate, but still a lot to do. The success of the Initiative has opened doors and there are new thresholds to cross. The Foundation has the opportunity to take the lead on several fronts. Our balanced scorecard analysis points the way to areas that need strengthening, particularly regarding the quality of programs on the ground and evidence for their effectiveness. We recommend that the Foundation identify the niche it wants to occupy, and the areas in which it will continue to lead. The Foundation should consider either directly supporting, or addressing the following via partnerships: ensuring that community workers are properly trained, accredited and remunerated; very young children receive the diverse foods they need to fuel their development; that sufficient small media learning aids are produced to make community work more effective and maintain changes in parent behavior, and that philanthropically funded programs get closer and more aligned to government provisions so that, at least with respect to some interventions, we can anticipate that they are provided for all children.
MasterCard Foundation, The;
Released in September of 2015, this strategy paper examines the challenges and opportunities to expanding access to education, skills training and financial services for people living in poverty in Africa.
Bill, Hillary & Chelsea Clinton Foundation;
A report released this week at the Third International Conference on Financing for Development found that there is a strong case for investing in Community Health Worker (CHW) programs as part of integrated health systems. The report was released by leaders from the Federal Democratic Republic of Ethiopia, the Republic of Liberia, the U.N. Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, Partners in Health, the Clinton Foundation, the African Leaders Malaria Alliance, and the MDG Health Alliance. The authors encourage domestic governments, international financers, bilateral and multilateral donors, and the broader global health community to finance and support the scale up of CHW programs as part of community-based primary health care through a set of specific recommendations. The authors participated in the crafting of the report and its recommendations as part of a distinguished panel chaired by Ray Chambers, the UN Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, and Prime Minister Hailemariam Dessalegn, President of the Federal Democratic Republic of Ethiopia.
MasterCard Foundation, The;
Released in July of 2015, this report examines the challenges of youth unemployment, particularly in Sub-Saharan Africa where some 600 million people are currently under the age of 25 and explores lessons learned from The MasterCard Foundation's portfolio of skills training programs. The report highlights the challenges that young people face in accessing quality and reliable economic opportunities. It documents the Foundation's work in developing holistic programs that provide not only formal skills training, but develop the foundational skills needed to navigate changing economic landscapes. The report also highlights that, in the absence of formal jobs, youth and young people will have to pursue a mixed livelihoods approach to income generation. Finally, the report discusses the scale of work needed in this field, and discusses trade-offs between running effective programs and the need to reach larger numbers of young people.