World Bank Report
A World Bank report released in October 2022 states worriedly that the progress toward achieving the U.N. Sustainable Development Goal of ending extreme global poverty by 2030 is off track. The report, “Poverty and Shared Prosperity 2022: Correcting Course,”states that around 7% of the world will still earn under $2.15 per day, the new extreme poverty standard. However, the World Bank has stated that this prediction may not come to fruition. The report lays out policies that could accelerate the decline in global poverty.

A 30-year Progress

In the past 30 years, the decline in global poverty has been nothing short of astounding. While nearly 1.6 billion of the world’s population lived in extreme poverty in 1990, the number is now only 8%. This 30-year period of unprecedented growth saw countries invest in social welfare programs. These social safety nets protect nearly 2.5 billion people and account for 36% of the reduction in global poverty as the World Bank stated.

The slowdown in the 30-year global poverty reduction progress has caused some concerns. From 1990 to 2015, the yearly poverty reduction rate generally remained above one percentage point, according to ODI. Today, the rate is now consistently under half a percentage point. Additionally, the fight against poverty has not had even distribution, with 700 million people in sub-Saharan Africa living in extreme poverty. Although the current definition is less than $2.15 a day, nearly half of the world lives with less than $5.50 a day which is an appallingly low amount. The COVID-19 pandemic appears to have worsened global poverty, at least in the short term. More than 70 million people lived in extreme poverty in 2020 alone, the largest single-year leap since 1990.

Takeaways From the World Bank Report

According to the World Bank report, the high inflation, shutdowns in COVID-19 economic programs and conflicts such as the war in Ukraine have slowed poverty reduction to a halt. Hence, although extreme poverty slightly decreased from 2020 to 2022, progress may stagnate. Given this new information, the World Bank report concludes that eliminating extreme poverty by 2030 is highly unlikely. For instance, many lower-income countries expect to see extreme poverty rates increase over the next few years. To achieve the goal of ending poverty, regions such as sub-Saharan Africa should develop at eight times the historical pace. As the report summarizes, ending extreme poverty by 2030 is already an ambitious goal and “recent setbacks have put this target nearly out of reach.”

The World Bank report is not all doom and gloom. With the exception of the Middle East and North Africa, the trend in extreme poverty is still one of decline. Most countries are exiting from their pandemic stupor and returning to normalcy. An earlier World Bank report stated that by 2023, the world economy would behave as it had prior to the pandemic. Growth may not be as high as in the rebound year of 2021 when the global economy’s GDP rose by 5.5%, but it will still increase by 3.2%.

Policy Changes

In addition, the World Bank report suggests a series of policy changes that could help steer extreme poverty reduction in the right direction. Even amid fears of a global recession and short-term crises, the World Bank has stressed the need to focus on long-term growth, including investments in education and health. They also have highlighted fiscal policy, manipulations of the money supply to change inflation and interest rates, as a tool to protect poor citizens. Borrowing for pandemic relief has been an effective way of preventing economic collapse, but doing this in the long term could lead to a strain on the budget, according to another 2022 World Bank report.

Continuing the Fight

The admission that one of the most important U.N. Sustainable Development Goals will not be achieved demonstrates how impactful the COVID-19 pandemic was, not just in the short term, but for ongoing projects since before the millennium began. At the same time, the World Bank report is a reminder that plans for the elimination of extreme poverty are always in flux, needing constant reworking to be effective and realistic. The 2030 goal may be out of reach, but the fact it was possible is a positive testament to successes in the fight against poverty.

– Samuel Bowles
Photo: Flickr

Food insecurity in GhanaMany consider Ghana “one of the most stable and democratic countries in West Africa.” However, poverty rates are high, standing at 25.5% in 2020, according to the World Bank. In the last 30 years, Ghana has made great progress in reducing poverty from a 49% poverty rate in 1990 to a 13% poverty rate in 2018. Still, inequalities exist between the north and south of the nation as well as between the urban and rural populations. During the lean season in 2020, the World Food Programme noted that more than 21,000 people suffered from food insecurity in Ghana, particularly in the northern region.

Difficulties in Northern Ghana

Food insecurity in Ghana is more severe in the north of the country largely due to climatic issues. In the northern region, 90% of Ghanaian households depend on agriculture for their livelihoods, however, this region only has one rainy season in comparison to the south, which has two rainy seasons. This climatic difference impacts food production and worsens both poverty and food insecurity in Ghana’s north. Farmer also face other issues such as “low [market] prices, poor road infrastructure, lack of access to finance, inadequate markets, post-harvest losses, insufficient education and knowledge[and] unsustainable farming systems.” Due to an agricultural dependence among rural people, food insecurity and poverty largely affect rural populations.

The World Food Programme (WFP) Combats Food Insecurity in Ghana

The WFP’s work in Ghana, in general, focuses on four key areas to fight food insecurity in Ghana.

  1. Private Sector Collaboration. To address stunting and nutritional deficiencies, the WFP provided support to the private sector to supply and promote “affordable and safe fortified nutritious foods.” For example, the WFP gave technical and financial assistance to two companies and linked these manufacturers to local small-scale farmers. The two Ghanaian companies manufacture Tomvita and Maisoya, which are fortified foods that improve the nutrition of pregnant and breastfeeding women. The companies aim to extend production to supplemental foods for children.
  2. Nutritional Assistance. The WFP partners with various government institutions to fight against food insecurity in Ghana and address nutritional deficiencies. The partnership aims to ensure citizens consume nutritious local-based diets and learn behaviors conducive to good health. The WFP also supplies electronic vouchers to supplement the nutrition of pregnant or breastfeeding women and children younger than 2.
  3. Food System Resilience. The WFP connects small-scale Ghanaian farmers to local markets “to increase the availability, access and utilization of staples foods” such as “maize, millet, cowpeas and soybeans.” So far, the WFP has connected “10,000 smallholder farmers to two industrial agro-food processing companies that produce specialized blended nutritious foods.” The WFP also aims to strengthen the food supply chain and ensure proper “post-harvest facilities, technologies and services” to improve the quality and safety of foods.
  4. Policy-Making Assistance and Capacity Expansion. The WFP is offering its support and services to improve Ghana’s existing programs and develop policies that focus on combating malnutrition and establishing adequate food systems. This involves connecting Ghana’s national school feeding initiative to the country’s agricultural arena. The WFP helps Ghana to implement food security monitoring measures and establish guidelines to “improve food quality and safety and emergency preparedness.”

Impact in Numbers

According to a WFP Ghana Country Brief published in August 2021, for the year 2021 overall, the WFP aimed to help 45,000 people through nutritional assistance. In August 2021 alone, more than 4,500 people “received direct food assistance through vouchers.” If one looks at the gender proportions of beneficiaries, women formed 72% of the beneficiaries while men accounted for 28%.  Moreover, in 2021, the WFP helped 22,020 small-scale farmers to increase their capacity and connect to markets.

Even though the WFP is seeing success in improving food insecurity in Ghana, worsening environmental conditions like drought stand as additional barriers to food security. Through ongoing support in strengthening the country’s food systems and resilience overall, Ghana can remain out of famine.

– Ander Moreno
Photo: Flickr

historic vaccine rolloutThe African Union (AU) has announced a deal that will send up to 400 million vaccines to 55 member states. The vaccines will go across the African continent in monthly shipments in order to fight the COVID-19 pandemic.

On August 5, 2021, Cyril Ramaphosa, the President of the Republic of South Africa made this historic vaccine rollout public. He reported that the AU had purchased 220 million doses of Johnson & Johnson’s COVID-19 vaccine in March. A possible 180 million additional vaccines can later be ordered.

How was the deal made?

In light of the COVID-19 pandemic, the African Union joined forces with the World Bank and other organizations to support The African Vaccine Acquisition Task Team. The team aims to provide rapid access to doses of the vaccine for the people of Africa. The team comprises ten members, including political leaders, health ministers, businessmen and philanthropists from all across Africa.

The World Bank will continue to support the AU in this historic vaccine rollout, supplying resources that will allow individual nations to purchase and distribute the vaccine. Additional assistance will come from the United Nations. UNICEF will assist with delivery and distribution management across the African continent.

Why Johnson & Johnson?

Each of the 400 million doses included in the deal will come from Johnson & Johnson.

The calculus behind this decision was thorough: Since the vaccine comes in a single dose, it is easier and cheaper to produce and administer. Moreover, the vaccine’s relatively long shelf life will ease logistical concerns. A recent study from South Africa reported high efficacy for the single-shot J&J vaccine, with up to 96.2 percent protection against death. The study also reported high protection against both the Delta and Beta variants of COVID-19 in Africa.

The most significant piece of the vaccine deal will take place right at home—part of the vaccine manufacturing process will occur in South Africa. Centralized at the Aspen Pharmacare facility in Gqeberha, South Africa, this insourcing of production will provide new jobs that will, in part, assist with post-pandemic economic recovery.

Where Africa Stands

As a continent, Africa lags behind in vaccination rates, which has placed economic stress on many nations. Vaccination rates also exemplify pandemic inequities that permeate the globe. As of July 23, 2021, only 2.2 percent of the African population has received a dose of any vaccine. In North America, more than half the population has received at least one shot.

These 400 million doses are enough to immunize more than one-third of the African population. At the same time, more work will need to take place in order for the continent to reach its 60% goal as it continues to adapt to and fight against the pandemic.

This new deal to bring in and produce vaccines provides hope that cases and deaths related to COVID-19 in Africa can decrease. It also helps cement the hope that even some of the most impoverished areas in Africa can recover from the pandemic.

Sam Dils
Photo: Wikimedia Commons

efforts to mitigate food insecurityAccording to the Council on Foreign Relations, about 135 million people experienced severe food insecurity before the COVID-19 pandemic. The pandemic has worsened this crisis with less access to quality food and prices skyrocketing. COVID-19 has already destroyed decades-worth of work made toward reducing global hunger. There are already predictions that millions of children will suffer more from malnutrition, obesity and stunting. Global hunger is an impediment to international development, increasing tensions within developing countries.

How Food Insecurity Worsened During COVID-19

The U.N.’s World Food Programme (WFP) states that millions of citizens across 43 developing countries face an “emergency phase of food insecurity in 2021.” The majority of those experiencing food insecurity in those countries are either refugees or anyone forced to migrate.

The Center for Strategic and International Studies reported that 272 million people are food insecure one year into the pandemic. Many believe that higher food insecurity rates worldwide occurred due to the shortages from panic buying and stockpiling. However, the U.N. Food and Agricultural Organization (FAO) determined that agricultural production reached its highest level. In 2020, the world produced 2.7 billion tons of the most commonly grown crops. The reality is that disruptions within the supply chain are the root cause of this worsening issue.

Actions of the World Bank

As part of its efforts to mitigate food insecurity during COVID-19, the World Bank increased funding for more effective agricultural systems in Guatemala to reduce disruptions in the supply chain. Its assistance also aimed to help alleviate the food insecurity caused by economic challenges and droughts. The World Bank helped Liberia by incorporating a Contingency Emergency Response Component that allows the government to respond to the needs of those at a higher risk of food insecurity. The component also helps increase crop production and helps normalize the supply chain there.

How to Overcome Economic Challenges

The pandemic also worsened the economic situation in developing countries. People received fewer remittances preventing them from accessing essential goods. Latin America has been most impacted by reduced remittances. However, food prices in other regions facing conflict became higher than many people’s daily salaries, making the situation difficult to overcome.

Haiti is a country with the highest food insecurity rates and faced severe impacts from the reduced remittances. The pandemic and reduced remittances hurt farmers the most. The World Bank assisted by providing programs with enough funding for farmers to produce enough crops for a two-year time frame. The programs will also help farmers incorporate safety precautions into their practices during the pandemic.

Other Efforts to Mitigate Food Insecurity

The World Bank’s other efforts to mitigate food insecurity included issuing a transfer of funds to families with food insecure infants and toddlers in Tajikistan to alleviate malnutrition. It sent food for 437,000 citizens in Chad facing food insecurity. The organization also provided additional funding that went toward addressing the concerns that the pandemic caused in Rwanda.

Accomplishments Occurring with the World Bank’s Help

The World Bank also provided more certified seeds to local communities in Afghanistan and helped farmers produce more yields than before. The U.S. sent $87.8 million to help provide more equipment for dairy and poultry farmers in Bangladesh. The World Bank’s programs in India resulted in further women’s empowerment with the establishment of women’s self-help groups that work with hygiene, food administration and storage. As of 2021, there are 62 million women that participate in these groups.

The World Bank also reports that farmers in developing countries face food insecurity and works to alleviate their distress. The organization helped Cambodia incorporate new agricultural practices that led to farmers receiving higher incomes with increased productivity. The World Bank also taught farmers in the Kyrgyz Republic the proper practices to grow more crops while conserving water. Eventually, more than 5,000 farmers gained an income that allowed them to buy essential goods.

The World Bank’s efforts to mitigate food insecurity in developing countries are effective so far. These international programs brought more farmers out of poverty and further combat global hunger. Many of these countries made commendable progress with this support, which is a significant step toward future development.

– Cristina Velaz
Photo: Flickr

3 Groups Creating Jobs in Underdeveloped CountriesPoor infrastructure and lack of job opportunities are among the top reasons that underdeveloped countries remain in poverty. Creating jobs in underdeveloped countries is key to achieving developmental goals and providing economic and political stability that can help many developing countries out of destitution. Furthermore, jobs provide income, independence and choice to individuals. It is for these reasons that creating jobs in underdeveloped countries can improve conditions and help in eliminating hunger and poverty. Creating new job opportunities can also help advance gender equality and many other pending societal issues.  In September 2015, many organizations came together to establish the U.N. 2030 Agenda for Sustainable Development, which recognized the importance and impact of jobs on these economies. Since then, corporations and organizations have been launching efforts to try and reduce global poverty by creating more jobs in developing countries.

3 Groups Creating Jobs in Underdeveloped Countries

  1. The Overseas Private Investment Corporation (OPIC): This U.S.-based finance development organization has long created jobs in underdeveloped countries that have boosted countries’ economies. OPIC has supported major infrastructure projects such as airports and hospitals, which have created many construction jobs. It also has provided and allocated financial resources to entrepreneurs in developing countries. These resources give entrepreneurs the means to start and grow their businesses, which will, in turn, produce more jobs. In 2019, OPIC merged with the Development Credit Authority, which was a part of the United States Agency for International Development (USAID), to form the Development Finance Corporation (DFC). The DFC partners with the private sector to invest in energy, healthcare and technology initiatives, as well as infrastructure and jobs.
  2. The World Bank: The international organization works to reach goals in the employment sector by launching efforts to improve financial access, provide financial training and build more robust infrastructures for lacking governments. Due to the World Bank’s international efforts, countries are recognizing the top challenges they face using job diagnostics. After evaluating data, governments can focus on more pressing socioeconomic issues. This will create jobs that benefit people in need and give them more economic stability. The World Bank counsels governments to invest in transportation, information and communications to connect more people to job markets. Finally, the World Bank is responsible for developing programs that promote entrepreneurship in small-and-medium-sized businesses.
  3. Mother’s Service Society (MSS): Founded in 1970, MSS is a social science research institute in Pondicherry, India, that leads research and conferences on subjects from global leadership to economic theory. MSS research projects and conferences develop action plans to increase employment and create jobs in developing nations. These plans detail multiple factors that, when combined, generate employment and boost the economies of these countries. According to MSS, the Newly Industrializing Economies (NIEs) in East Asia have demonstrated that more comprehensive strategies for job generation have yielded the most progress. More comprehensive strategies for job generation can include ideas such as having more of an emphasis on agriculture, promoting small businesses, improve marketing efforts, develop exports and employment planning.

More Strategies

Besides the great work of these groups, other comprehensive strategies for creating jobs in underdeveloped countries include extending basic education, improving higher education, raising productivity and upgrading the skill level of workers. By implementing these strategies, economies can close socioeconomic gaps, join the global market and create more job opportunities.

– Annamarie Perez
Photo: Flickr 

Microfinance in CambodiaFinancial institutions, like banks, are vital for the creation, collection and management of a country’s currency. In Cambodia, the microfinance industry acts as a banking system for many people, with around 160,000 branches across Cambodia in 2016. Of the 10 million people in Cambodia, a little more than one in five people have taken out some sort of microloan. Average loans are more than twice as much as the country’s average yearly GDP per person. Microfinance in Cambodia has the potential to help people trying to survive the COVID-19 pandemic and avoid poverty, but it does not come without consequences.

The Microfinance Boom

In Cambodia, predatory loan sharks with exorbitant rates were the norm until microfinancing came into prominence. Microfinancing offered lower interest rates and shifted residents toward more formal money lending institutions. Microfinance institutions have allowed people to rise out of poverty because people are able to start businesses, fund their education and pay for emergency healthcare. The Cambodian Microfinance Association (CMA) sees a clear link between access to credit and reduced levels of poverty. The benefits of microfinance help Cambodia to develop and expand economically. For instance, for farmers who would typically be unable to access improved agricultural equipment, microfinance in Cambodia means sustaining a livelihood.

The Impact of COVID-19

The credit boom in Cambodia did not come without consequences. Firstly, the size of household debt exploded. The average microloan borrower in Cambodia has $3,800 worth of debt, the highest in the world. The IMF and the World Bank have warned that an improperly regulated microfinance industry can push Cambodians further into debt and further into poverty. In 2017, when the Cambodian government responded with policies to cap the interest rates, microfinance institutions, in turn, garnered more money through increased loan fees. Due to the poverty brought on by COVID-19, the debt crisis in Cambodia ballooned. The CMA reports that in March 2020, in response to the impacts of the pandemic, repayments were paused for about 25,000 people and roughly 25,000 loans were restructured to ease financial pressures.

The Outlook of Human Rights Watch

In spite of some debt relief procedures during COVID-19, many Cambodian families are still pushed to the brink of selling their homes and land in order to pay back debts. The Cambodian government received criticism for not doing enough to help indebted Cambodians. Human Rights Watch (HRW) recommended that Cambodia “urgently suspend debt collection and interest accruals for micro-loan borrowers who are no longer able to meet their debt payments due to the COVID-19 pandemic.”

According to Phil Robertson, deputy director of HRW’s Asia Division, “Many Cambodians fear losing their land more than catching the novel coronavirus because they can’t pay back their loans and the government has done little to help them.” When land collateral strips Cambodians of their homes, their ability to remain out of poverty is severely threatened. The poorly regulated microfinance industry in Cambodia risks becoming a catastrophe because of the lasting effects of the pandemic and little government action.

The Way Forward

Hun Sen, the prime minister of Cambodia, remains optimistic about the future of microfinancing in the country. In June 2020, Sen committed to dedicating about $25 million per month to help roughly 600,000 indebted and impoverished families in Cambodia. The National Bank of Cambodia has called upon lending institutions to restructure or defer loan repayments for those in economic struggles. The HRW feels more needs to be done and has provided guidelines in this regard combined with close monitoring of the situation.

– Alex Pinamang
Photo: Flickr

The World Bank's Crisis Response
In early October 2020, the president of the World Bank Group (WBG) gave a speech to address the COVID-19 pandemic and the World Bank’s crisis response. In his speech, WBG president David Malpass discussed the enormous toll that the COVID-19 pandemic has had on developing countries. He also stated that the World Bank’s response would focus on alleviating poverty, inequality and debt burdens, and support educational and health opportunities.

Disparities

Dramatically uneven access to Personal Protective Equipment (PPE) across the globe is one indication of global disparities in economic well-being, which in turn have affected pandemic response capabilities. Lowering the transmission of COVID-19 requires the coordination of a globalized response. However, localized country-wide challenges in securing PPE, the most basic of pandemic safety necessities, prevent this possibility.

Illustrating this challenge is the fact that low-income countries have little economic agency to act during the global pandemic. Developed countries may face shortages in supplies of PPE. Those countries may even opt to reduce the supply of outgoing PPE sales in order to remediate domestic shortages. However, restrictive budgets, few local manufacturers and no way to import PPE exacerbate shortages in developing countries.

A 2020 National Institute of Health study estimated that if countries tightened up sales of PPEs, “export restrictions could initially increase prices of medical masks by 20.5%, Venturi masks by 9.1%, and protective equipment, such as aprons and gloves by 1% and 2% respectively” around the globe. Illustrating the problem, a recent survey of seven low-income developing countries across the world showed that on average, clinics and health centers were only able to supply two of four necessary PPE items to medical staff. The challenges presented by PPE distribution demonstrate the importance of the World Bank Group’s aid programs around the world.

Dual Challenges

Lockdown guidelines that have successfully “flattened the curve” in developed nations are not always a viable option for developing economies. For example, in India, nearly 90% of the workforce is in the informal employment sector. In sub-Saharan Africa, 86% of workers have informal employment. The nature of informal work requires workers to leave the house for work and as a consequence, choose between keeping their families fed or respecting lockdowns. Countries that struggle to lower transmission rates or offset the financial damage of lockdowns see dual challenges. Implementing measures that “flatten the curve” and lower transmission rates cause economic harm. On the other hand, failing to reduce hospitalizations inflicts strain on medical systems, leading to high infection rates and death tolls.

“A Fire That Must Be Put Out”

In the World Bank Group’s June 2020 COVID-19 Crisis Response Approach Paper, the ongoing COVID-19 crisis is described as “a fire that must be put out.” As a direct result of the pandemic, for the first time in 60 years, the World Bank projected that Emerging Markets and Developing Economies (EMDEs) will see economic contraction. The global economy will likely shrink by 5.2% in 2020, the deepest recession since World War II. For comparison, the global economy shrank less than 2% during the 2009 financial crisis. A number of traits cause EMDEs to be especially vulnerable to the pandemic’s negative economic impacts. Traits such as weaker health systems, dependence on global trade and tourism exacerbate financial instability. For the first time in decades, global poverty will rise.

The World Bank Group’s Response

Despite challenges, international financial institutions, including the WBG, are moving quickly to prevent the loss of hard-won development growth in EMDEs. The WBG has recognized the new paradigm of the pandemic and as an organization, has shifted its focus to a crisis response agenda. In April of 2020, the WBG announced the first projects directly related to COVID-19 and prepared to deploy up to $160 billion over a period of 15 months to address COVID-19.

Like other international organizations, the World Bank’s crisis response to COVID-19 aims to focus on issues directly related to the pandemic. However, the WBG ensures a continuation of its broader development objectives by placing its COVID-19 crisis response agenda within its own Twin Goals. Adopted in 2013, its Twin Goals are to bring extreme poverty down and to promote prosperity among the bottom sector of every country. The WBG’s massive $160 billion project rollout focuses on direct response to COVID-19, and on protecting past economic development gains. This includes maintaining steady progress towards the Twin Goals.

The World Bank’s current crisis response agenda can be divided into near, medium and long-term agendas. These agendas are termed relief, restructuring and resilient recovery. Relief relates to dealing with the most direct impacts of COVID-19. Its restructuring plans include strengthening health systems, restoring human capital and restructuring social and economic sectors. Resilient recovery is about building a future in recognition of a changed post-pandemic world. In pursuing these plans, the WBG ultimately aims to assist at least one billion people affected by the pandemic.

– Marshall Wu
Photo: Flickr

Healthcare in Armenia
Armenia is a mountainous nation of nearly 3 million people. It neighbors Iran, Georgia and Turkey. Over the past three decades, healthcare in Armenia has undergone a slow reform. The country is transitioning from an inefficient model of centralized healthcare to a modern system focusing on family medicine. Many Armenians feel dissatisfied regarding their healthcare system. However, organizations like the Health for Armenia Initiative and the World Bank are working with the Armenian government to improve options for Armenians.

Armenia’s Healthcare History

Healthcare in Armenia during the Soviet era was a centralized medical system. Experts state that the Soviet system was technologically underdeveloped and inefficient. The healthcare model focused on centralized care in hospitals and medical professionals were highly specialized.

Armenia declared independence in 1991, and healthcare in Armenia underwent radical changes. Local governments took over primary health care sectors while regional governments gained ownership over hospitals. Armenia’s State Health Agency is now in charge of the healthcare system. The government allocates resources to these publicly owned facilities. Since its independence, Armenia has implemented many healthcare reforms. A major piece of legislation called the “On Medical Aid and Medical Services for The Population” created a system that allows patients to help pay for healthcare services. This development plays a role in why Armenians find themselves funding most healthcare expenditures with out-of-pocket expenses.

Armenians in certain years paid up to 89% of healthcare charges in out-of-pocket expenses. This is incredibly taxing, given that Armenians earn an average per capita household income of around $1,500 USD. Their inefficient and expensive healthcare system places a heavy financial burden on impoverished peoples. Patients are slowly transitioning to primary healthcare providers with financial regulations replacing older regulations. However, a lot of work is still ongoing to improve the healthcare situation in Armenia.

How Armenians Feel About Their Healthcare

A 2018 report outlined a recent picture of healthcare in Armenia. Around 400,000 people in Armenia are poor or near-poor. Meanwhile, at least 233,000 of these people are part of a vulnerable group including the disabled, children and the elderly. In 2014, 31.8% of the poorest of Armenians reported that they were sick for more than three days, but they did not seek treatment because of financial reasons. Only 4.2% of the richest Armenians made the same decision.

A public opinion report that BMC published in 2020 outlined the current feelings the Armenian people have towards their healthcare system. The researchers polled over 500 Armenian citizens about the country’s healthcare system. Nearly half of respondents did not believe that citizens had equal access to healthcare in Armenia. Almost 70% of respondents felt that the government should have a larger responsibility towards an individual’s health which included funding healthcare services.

The Healthcare for Armenia Initiative’s Mission

Armenian natives and internationals formed the Healthcare for Armenia Initiative (HAI) in 2016. The initiative’s team focuses on bottom-up reforms to increase rural Armenians access to the constitutional right to healthcare. HAI’s projects focus on developing and maintaining healthcare professionals that can provide services in high-need areas.

HAI defines its work around six pillars, and among these pillars are education, research and leadership. It focuses on these three by holding workshops. It held a two-day workshop in partnership with the National Institute of Health of Armenia where it “[discussed] how to improve health education and healthcare in Armenia.” Organizations like HAI have helped to inform recent changes in government policy that will hopefully address the healthcare needs of the Armenian people.

Recent Changes for Healthcare in Armenia

The Armenian government in partnership with the World Bank published a guideline for the Health System Modernization Project. The main goal of the partnership is to improve access, quality, efficiency and governance for Armenian healthcare. The project focuses on adopting an efficient family medicine model. The transition to a family medicine model requires training new doctors that are not overspecialized.

A major priority of the project was to train the number of healthcare professionals necessary to run a family medicine-style healthcare system. At a final cost of nearly $6 million USD, this project component costs less than the projected $7 million. This key part of the project trained 980 family medicine doctors and nurses. The World Bank reports that these numbers should support 60% of the country’s needs.

Armenia and the World Bank cooperated on three other major components as part of this modernization project. They optimized and renovated the hospital network. The project reorganized the Armenian Ministry of Health so the agency could better function as a regulator of healthcare. These reforms gave the Ministry of Health many monitoring tools to efficiently implement and regulate the healthcare reforms the country is undergoing. Armenia’s government also established the Health Project Implementing Unit (HPIU). HPIU is a part of the Armenian Health Ministry that monitors, reports on and provides strategic planning for the overall healthcare modernization project. All of these developments cost around $30 million USD to achieve.

Where Healthcare in Armenia Stands

Healthcare in Armenia is an inequitable system in the process of reforms and transition. Armenia with the help of national and international institutions is moving to a family medicine system that meets the financial and medical needs of its people.

Jacob Richard Bergeron
Photo: Flickr

Lead Poisoning in Children
For more than a century, the people of Kabwe, Zambia have lived with devastatingly high levels of lead exposure. In 1994, after 90 years, Kabwe’s lead mine shut down. More than 25 years later, the people of Kabwe still suffer the consequences of decades of unstable mining and nearly nonexistent clean-up efforts by mine owners. Environmental health authorities say Kabwe has unprecedented levels of lead contamination leading to lead poisoning in children.

The EPA “defines a soil lead hazard as 400 parts per million (ppm) in play areas and a 1,200 ppm average for bare soil in the rest of the yard.” Black Mountain, a favorite place for Kabwe’s children to play, measures a staggering 30,000-60,000 ppm. The “mountain” is a massive heap of refuse. Adults often crawl through make-shift tunnels mining for lead, copper, manganese and zinc to sell. With more than half of Zambia’s population living below the poverty line, mineral scavenging provides vital income. Many people who venture beyond the “DANGER KEEP AWAY!” warning outside the mine site, say the risk of lead poisoning is a necessity if they want to feed their families.

Children at Risk

Lead poisoning in children is at a disproportionate rate due to children’s developing bodies and brains. Children absorb four to five times more lead than their parents. Lead exposure can result in skin rashes, poor appetite, weight loss, cough, stunted growth, learning disabilities and death. Often, lead poisoning goes undetected until it is too late. Many families will hide their lead-poisoned children because they fear stigma due to their child’s symptoms. In Zambia, 45.5% of children live in extreme poverty. As a result, they do not often have access to proper healthcare to treat lead poisoning.

The World Bank Project

The World Bank is funding a $65 million project, the Zambia Mining and Environment Remediation and Improvement Project (ZMERIP). The project aims to reduce environmental risks in lead hot spots. It also seeks to assist the Zambian government in addressing the dangers of lead exposure and implementing safety protocols, providing health intervention and engaging mining companies in expanding awareness of their environmental and social responsibilities.

In 2020, the ZMERIP began the largest health intervention to address blood lead levels (BLLs) in children in Zambia. More than 10,000 children received lead poison testing. The CDC recommends a BLL in children of no more than 5 µg/dl. Of the children tested, 2,500 had BLLs of 45 µg/dl or more. Chelation therapy, “which binds the lead into a compound that is filtered out through the kidneys”, is the preferred treatment for children who test 45 µg/dl or higher. Children who test lower, receive vitamin supplements, iron and protein as treatment.

The World Bank attempted another project similar to the ZMERIP in 2011 but achieved little progress. With lessons learned, the World Bank is hopeful this new project will be successful. If the project attains the goals it has set out to complete, more than 70,000 people including 30,000 children will benefit from the information. While some Zambians have yet to realize the risks of lead exposure, the World Bank reports mostly positive responses to their health advocacy.

The Future for Zambia

For the children of Kabwe, the ZMERIP offers hope of reducing lead poisoning in children. It offers hope that play is not a risk and a toddler’s appetite for a fistful of dirt is not a life sentence by lead poisoning. The key to the project’s success is continuing prevention practices, education, remediation and the Zambian government’s obligation to enforce safety regulations after the project’s completion expected in 2022. The ZMERIP’s commitment places focus on improving the lives and futures of Kabwe’s most vulnerable and valuable asset, its children, the country’s future.

Rachel Proctor
Photo: Wikipedia Commons

Bank Access in Afghanistan
Bank access in Afghanistan is a step toward financial inclusion for the rural poor. According to Jan Chipchase and Panthea Lee’s research on the nascent mobile-phone-based financial services that were available in Afghanistan in 2010, theft and bribery plagued the banking system. Person-to-person transfers were not widely available until the creation of the M-Paisa mobile money transfer service. Roshan launched the M-Paisa mobile money transfer banking in Kabul in 2010 when 83 bank accounts existed per 1,000. Through this service and other programs, improvements in the availability and quality of bank access in Afghanistan have been a major contributor towards reducing income inequality and poverty.

Gradually Improving Access

With limited credit available, Afghans were hiding money at home under the mattress, and forms of money ranged anywhere from banknotes to gold jewelry to livestock. The rural poor did not trust the banking system, and the use of the word “Paisa” helped to make the service seem more trustworthy, although it posed access challenges for the rural poor. By 2014, banking access improved for 40% of Afghanistan’s population, with a 7% increase in the availability of financial services. However, access to credit was still out of reach to the rural poor as most of the banks were located in Kabul province, an urban area. This made it more difficult for rural people to get loans to start businesses.

In 2015, a project to bolster bank access in Afghanistan made a step toward financial inclusion for the rural poor with the start of the Afghan Rural Enterprise Development. The project sought to integrate rural agricultural communities into the economy. Employment opportunities emerged in poor rural villages by the creation of savings and enterprise groups along with loan associations. According to The World Bank, the rural poor received assistance in building their own businesses, which increased the value of trade, ensuring new opportunities. This created access to credit through internal lending, which focused on small and medium-sized enterprises, or SMEs. This program was so important because it targeted people who traditionally could not access the banking system.

The Reason it Matter

As of November 2019, more data exists to support the successes of bank access in Afghanistan that The United Nations Economic and Social Commission for Asia and the Pacific published. The goal of the report was to assess the status of financial inclusion for all adults in Afghanistan age 15 to 64 including women. Financial inclusion in a “broad range of quality and affordable financial services including but not limited to account, payment, saving, and credit provided by formal financial institutions in a fair, transparent, and sustainable manner.” According to this presentation, 15,000 bank accounts exist per 100,000 adults, and in 2021, projections determined them to be 20,000. Expectations have determined that mobile money accounts and accounts that women hold will also grow during the same period. Although the success of banking the unbanked in Afghanistan has been slow, steady progress has occurred toward financial inclusion of the rural poor and women.

It is clear that bank access in Afghanistan and credit is allowing the rural poor in Afghanistan to do better financially. However, according to the World Bank Afghanistan, “the COVID-19 crisis will have a serious and sustained impact on Afghanistan’s economy. Recovery is expected to take several years, with new investment constrained by political uncertainties, continued insecurity, and questions around ongoing international support.” It is important to maintain international support for improving banking access to preserve opportunities for Afghanistan’s rural population.

Kathleen Shepherd-Segura
Photo: Flickr