Healthcare in MozambiqueThe state of healthcare in Mozambique has drastically changed in the last few decades. While Mozambique was once a country with little access to healthcare services, the country has decreased mortality rates since the launch of its Health Sector Recovery Program after the Mozambican civil war, with assistance from the World Bank.

History of Mozambique

The Mozambican civil war that took place from 1977-1992 had lasting effects on the country’s healthcare system and economy, resulting in limited funding for health services and insufficient access to care providers.

The Health Sector Recovery Program was launched in 1996 in order to refocus on funding healthcare in Mozambique, which desperately needed expanded resources to address the growing health crises. New health facilities were constructed throughout the country increasing accessibility to healthcare. The number of health facilities in Mozambique from the start of the civil war to 2012 quadrupled from 362 to 1,432 and the number of healthcare workers increased along with it.

Improvements to Healthcare and Accessibility

About 30 years ago, Mozambique had one of the highest mortality rates for children under 5 but was able to significantly reduce this number after the success of the Health Sector Policy Program. In 1990, this rate was 243.1 mortalities per 1,000 children. The rate has been reduced to 74.2 mortalities as of 2019. Maternal health was also targeted by the program, with increased health facility births from 2003 to 2011.

Conflict in Cabo Delgado

Despite these improvements to healthcare in Mozambique, Cabo Delgado, a northeastern province, is facing one of the worst healthcare crises in the country since violence struck the area in October 2017. Conflict between non-state armed forces clashing with security forces and other armed groups has caused more than 200,000 people in the area to become internally displaced. Coupled with the aftermath of Hurricane Kenneth, one of the strongest hurricanes to hit Africa, the area is facing severe food shortages and lack of shelter for people.

Cabo Delgado has also seen a rise in COVID-19 cases and other diseases such as cholera, diarrhea and measles, resulting from inadequate clean water and sanitation.

Intervention by UNICEF

On December 22, 2020, UNICEF shared a press release on the increased need for healthcare in Cabo Delgado. As the rainy season begins, there is an increased risk for deadly disease outbreaks. It appealed for $52.8 million in humanitarian assistance for 2021 projects aimed at aiding Mozambique.

UNICEF is expanding its water and sanitation response in order to prevent the outbreak of water-borne diseases like cholera and the further spread of COVID-19.

UNICEF also aims to give crucial vaccines to children in Mozambique, increasing its numbers from 2020. The 2021 targets include vaccinating more than 67,000 children against polio and more than 400,000 measles vaccinations. Children will also be treated for nutritional deficiencies from food insecurity and UNICEF plans to screen more than 380,000 children under 5 for malnourishment and enroll them in nutritional treatment programs.

Mental health support services will be provided to more than 37,000 children and caregivers in need, especially those experiencing displacement from armed conflict and those affected by COVID-19.

The Future of Healthcare in Mozambique

While healthcare in Mozambique has significantly improved in the last few decades, a lack of health services still affects the country’s most vulnerable populations. Aid from international organizations like UNICEF aims to tackle these issues to improve healthcare in Mozambique.

– June Noyes
Photo: Flickr

Life Expectancy in JapanYear after year, Japan consistently ranks as one of the top countries for life expectancy. These top 10 facts about life expectancy in Japan is a reflection of economic developments that occurred since World War II.

Top 10 Facts About Life Expectancy in Japan

  1. Japan ranks second in the world for life expectancy, with the average Japanese citizen living to 85.0 years. The life expectancy for the average female in Japan is 88.1 years and 81.9 years for males. There has been a fairly consistent difference in the life expectancy between women and men in Japan. Currently, women are expected to live around 6.2 years longer than men. Prior to 1990, the country had not even made the list of the top 100 countries with the highest life expectancies.
  2. The fertility rate in 1955 for Japan was 3.0 live births per women, which has decreased to 1.4 in 2020. A decrease may appear worrisome but there is a clear correlation between fertility rates and wealth. Poorer nations tend to have high fertility rates which continues a cycle of poverty but intermediate levels of fertility tend to represent an economically stable, wealthy country.
  3. Infant mortality and overall child mortality rates have greatly decreased since the 1950s. In 1950, the infant mortality rate was roughly 47 deaths per 1,000 births and the number of deaths for children under 5 was 72 per 1,000 births. As of 2020, the infant mortality rate and deaths for children under the age 5 is 1.6 and 2.2 per 1,000 births, respectively. These statistics display growth that has contributed to a higher life expectancy in Japan.
  4. Diet and lifestyle are major contributors as well. Japanese people tend to enjoy well-balanced, nutritious meals that consist of vegetables, fruits, fish and high-grain based foods. This diet is low in saturated fats and includes mainly natural, unprocessed foods. In addition, the country has succeeded in promoting a healthy and active lifestyle. Even in their old age, many Japanese seniors continue to exercise regularly.
  5. Rapid economic growth was seen in the country in the 1960s and the Japanese Government made great efforts to invest in the country’s healthcare system. In 1961 the country adopted universal health insurance for their citizens which included vaccination programs and medical treatments that greatly decreased both adult and child mortality rates.
  6. Increased economic prosperity is a contributing factor. After World War II, Japan experienced an extremely rapid growth in its economy. Increased economic prosperity led to medical technology advancements, universal healthcare access, improved diets and lifestyles, decrease in disease and deaths, improvements in education and lower mortality rates. Economic prosperity and life expectancy rates are related, as seen in Japan.
  7. A smaller poverty gap can also account for life expectancy in Japan. In the 1970s, Japan had a smaller income and wealth gap in the population compared to many other developed countries and it has been proven that a higher inequality in wealth correlates to higher mortality rates.
  8. Successful health education and a well-established health culture is what Japan is known for. Majority of citizens engage in regular physician check-ups and receive vaccinations and immunizations. Furthermore, Japanese people are encouraged to reduce their salt intake and red meat consumption, advice the people take seriously.
  9. Practice of good hygiene is another factor in explaining the high life expectancy in Japan. Common practices such as handwashing and cleanliness is normal in Japan but the country also has sufficient access to clean, safe water and sewage systems as well.
  10. Decreased cerebrovascular diseases. Historically, Japan has always had low rates of ischemic heart disease and cancer compared to other developed, high GDP countries. However, Japan had one of the highest rates for cerebrovascular disease from the 1970s-1980s. Thanks to health developments, Japan has greatly decreased their rates of cerebrovascular diseases within the past 20 years.

– Bolorzul Dorjsuren
Photo: Flickr

Clean Water

Each year, 289,000 children under the age of five die due to diseases caused by poor water quality and sanitation. This means that one child dies every two minutes and 800 children die per day because they do not have access to clean water or proper sanitation.

On August 29, UNICEF made a statement that declared that access to clean water is a right – not a privilege – and that in countries facing conflict or instability, clean water must be made a priority. The lack of clean water and sanitation is particularly alarming in areas that are in the middle of conflicts; more than 180 million people in crisis-ridden areas do not have access to clean drinking water.

To ensure that children are given their rights to clean water and sanitation, UNICEF has developed an initiative called WASH, which stands for water, sanitation and hygiene. Their goal is to achieve universal access to sanitation, hygiene and safe drinking water by 2030. Through a team that works in more than 100 countries, UNICEF has been able to provide close to 14 million people with clean water and more than 11 million with toilets.

UNICEF is not the only group working to improve access to clean water and sanitation. Pure Water for the World is a nonprofit organization that works closely with underserved communities in Central America and the Caribbean, which gives residents the resources and knowledge to be involved in water projects in their communities. In their 18 years of existence, they have reached more than 750,000 people in Haiti and Central America with solutions to water, sanitation and hygiene problems. Pure Water for the World seeks local and international volunteers and donations to keep the organization running.

Water for Good specifically targets the Central African Republic in its efforts to increase access to clean water and sanitation. They use local businesses for supplies and resources to start sustainable water programs, with over 90 percent of them being functional long after Water for Good has done their part.

Charity: Water is another nonprofit organization that provides clean water to struggling populations. They rely on private donors to fund their operation costs, so all of the money donated to Charity: Water goes directly into funding water projects. The company also follows up each water project with a detailed report of its results and locations, so donors can know exactly where their money has gone.
All of these nonprofits are working toward UNICEF’s ultimate goal – to have worldwide equal access to clean water, sanitation and hygiene for children – which is, as UNICEF states, not a privilege, but a right.

Téa Franco

Photo: Flickr

Ending Water ScarcityAn international organization believes in ending water scarcity in developing countries. Water For People is a non-profit that focuses on establishing proper infrastructure and sanitation to remedy the lack of clean water around the globe.

They are especially concerned with the impact water scarcity has on women and girls, who often bear the burden for water collection.

They work at the ground level to build trust within the community and by tailoring their solutions to the issues at hand. Local governments, community members and business owners are all required to co-invest, ensuring that all partners have an equal stake in the results. This collaboration allows for a better understanding of the abilities of a community to finance and maintain the projects for the future.

The U.N. states that more than 2 billion people are affected by water scarcity. That figure is expected to rise due to climate change. This is especially problematic for developing countries struggling with poverty.

According to Jim Yong Kim, president of the World Bank Group, “Economic growth in some regions could be cut by as much as six percent because of water scarcity alone.”

That is why one of the U.N.’s Sustainable Development Goals for 2030 includes improved access to clean water and sanitation. There are several targets for doing so, including moves to:

  1. End open defecation, which can threaten the viability of water resources;
  2. Improve water quality by reducing pollution, dumping and the release of hazardous materials;
  3. Protect and restore water-related ecosystems;
  4. Support the participation of local communities in improving water management;

This last target is where Water For People comes in. The organization, which was established by the American Water Works Association (AWWA) in 1991, has provided access to clean water in nine developing countries: Honduras, Guatemala, Nicaragua, Bolivia, Peru, Malawi, Rwanda, Uganda and India.

Sanjay Wijesekera, UNICEF’s global head of water, sanitation and hygiene put it simply: “No matter where you look, access to clean drinking water makes a difference in the lives of people.”

The fight for ending water scarcity is ongoing but there continues to be an increase in access to clean water thanks to Water For People.

Sabrina Santos
Photo: Flickr

Target Year 2015: Increases in Water Access Mark Progress in Achieving Millennium Development Goals
When the Millennium Development Goals (MDG) were established in 2000, 2015 was designated as the target year to achieve many improvements in access to basic human rights such as water and basic sanitation.

Access to water ensures reliable sources of safe drinking water, and basic sanitation guarantees hygienic separation of human excreta from human contact. The MDG established a mission to halve the number of people worldwide without sustainable access to sanitation and drinking water between 1990 and 2015.

According to the United Nations, the world successfully halved the number of people without access to drinking water by 2010, and by 2015, a total of 2.6 billion people gained water access. Meanwhile, 2.1 billion people have gained sanitation access in this time. However, 2.4 billion people have still not seen improvement in this area.

The benefits of clean water access and sanitation are countless, as safe water is a fundamental building block to security in other areas of life. According to ONE, for every $1 invested in water and sanitation, there is at least $4 of increased economic opportunity in developing nations.

Also according to ONE, with universal water access and sanitation, the globe would receive approximately $32 billion of economic benefits annually due to reductions in healthcare costs and increased work productivity from increased standards of life.

A reporter from ONE notes that $22 billion would be generated just in Africa and that African women would be especially impacted by such access. Research has demonstrated that clean water and sanitation has had the power to increase school enrollment rates for females by more than 15 percent in relevant areas.

Despite improvements, the world still has a far journey to travel, which has been a big topic of discussion throughout MDG Target Year 2015. Especially with regard to sanitation, the world has reaffirmed its commitment to improving sanitation standards moving forward.

The Stockholm International Water Institute (SIWI) annually hosts World Water Week to discuss these issues. This year’s theme was Water For Development, accordingly, to reestablish a global focus on sustainable development for impoverished nations.

Held recently at the end of August, world leaders gathered to discuss the importance of the United Nations Sustainable Development Goals in the future.

Arin Kerstein

Sources: ONE, United Nations Millennium Goals, United Nations Water
Photo: Google Images

Ethiopians embrace sanitary improvements
Going to the bathroom: a subject that, as humans, we like to pretend doesn’t even happen most of the time. However, for rural Ethiopians living without the most basic sanitary structures, an initiative to improve latrine use was one which needed to happen.

In the village of Kurt Bahir, local carpenter Kefale Demelash used his skills to build a two-room latrine for public use within the village after becoming inspired to initiate sanitary improvements after a diarrhea outbreak plagued the area.

For this particular latrine, one side was designated for women and the other side for men. Smaller pits were also dug for children which would be safer than customary ones, encouraging the young to start the habit of using them early.

With just the establishment of this one latrine, others were motivated to create their own. Soon, with the help of Demelash, 126 latrines were created within Kurt Bahir, all meeting the international standards for improved sanitation. These new latrines would help reduce the risk of communicable diseases, which are commonly spread by unsafe sanitation practices.

Demelash was able to receive training as a village coordinator through the government’s Health Extension Program (HEP), which trains and deploys members into rural areas of the country to educate and promote sanitary practices.

Further progress in sanitation is also being made through the Water and Sanitation program (WSP), a five-year multi-donor partnership between the World Bank and the government.

The World Bank describes the program goals as “scaling up its capacity, improving sanitation and hygiene services and increasing access by the poor in 104 selected districts in Amhara, Oromia SNNP and Tigray regional states.”

Ethiopia has suffered through many different kinds of communicable diseases attributed to poor hygiene and sanitation. However, with the execution of the government’s Universal Access Plan (UAP), it is hoped that sanitation can be improved by 100 percent.

Currently, more than 7 million people have been educated on healthy sanitation practices by 1,782 trainers and implementers under the program. Prior to the program, open defecation was a recurring problem, but with the organization in full-swing, 52 percent of the kebeles (an administrative unit within Ethiopia) in the woreda (districts) are defecation free.

Taking a creative approach in the program’s expansion strategies, prizes were offered within villages. This was initiated by a local “savings mechanism” through the woreda, where the prize money was given to the best innovator, performer or implementer of an improved sanitation project.

With this strategy in mind, neighbors found inspiration in one another, which ultimately led to improvements across woredas.

The World Bank found “in Mecha and Medebayzana woredas, more than 55,000 households now have improved latrines, and communities have also started applying the sanitation lessons they learned in their daily lives, such as keeping their homes, compounds and communities clean, making themselves safer and healthier.”

Nikki Schaffer

Sources: World Bank, We Are Water
Photo: Flickr

Water and sanitation. Proper access to both is an issue that bedevils developing countries all over the world, and Kenya is no different. A new water-dispensing service is trying to change that.

Water has always been a huge issue in development work. Its importance is paramount to life itself – without water, humans cannot survive. While millions of people in the developing world do have access to water, oftentimes it is not safe for drinking. This causes diseases to spread and death to follow.

The Millennium Development Goals (MDGs) set out targets for clean drinking water. Goal 7, Target 7.C’s aim was to “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” This goal was met five years ahead of schedule – between 1990 and 2012, 2.3 billion more people gained access to safe drinking water. However, some have claimed that Target 7.C set the bar too low in terms of achievement.

A major issue connected to clean drinking water is access to proper sanitation for all. While the clean drinking water MDG has been met, sanitation has not done as well. One billion people still openly defecate all around the world, for lack of a better option. This then affects drinking water – it is a vicious cycle.

Part of the problem with supplying clean drinking water to the world’s population is that it is growing, making the task even harder. The population of Nairobi in 1963 was 300,000. Now, it is home to 4.2 million, and this figure is expected to grow to 14 million by 2050. If the world cannot supply its current population with clean drinking water, then how will it possibly keep up with the globe’s rapidly expanding populace?

The answer might begin with four new water dispensers that have been installed in Nairobi’s slums, which might help to change Kenya’s water infrastructure. They operate like vending machines – put money in, and water is dispensed out. This has reduced both the cost of water for slum residents as well as the distance needed to travel to acquire it. The water is purer and cleaner than other options – before the machines were installed, many residents got their water from sellers that dragged jerry cans on carts through the streets. Without water pipes in the slums, this was the only option.

The water-dispensing machines present a cheaper and cleaner option than the street vendors. It is a win-win situation for all involved – the government, who has put the machines in place, makes money on the water, and the citizens pay cheaper prices. Before, people would venture to neighborhoods with water pipes and break them to siphon off water, essentially stealing water from the government.

Now, prices are six times cheaper than they were before. Pre-dispensing machine, water prices hovered around three shillings, the equivalent of around three pennies in the U.S. Now, prices have been reduced to half a shilling. This might not seem like much, but to some that are unemployed or only make US$2 a day, the reduction is huge.

The payment system is done through mobile payments or water smart cards that residents can load money on. The machines are also operated by local residents who earn up to 40 percent of the profits from the machines as an incentive to keep them running and prevent vandalism. If Nairobi can continue to set an example for what these machines can do, they might go much further than a few slums in Kenya’s capitol.

– Gregory Baker

Sources: The Guardian, All Africa, UN
Photo: Stratfor

Today, cities in Africa are rapidly urbanizing. The population is growing faster than infrastructure is being built, which causes a shortage of sewage and sanitation systems, especially in impoverished areas.

Over 2.6 billion people do not have access to sanitation. Every day, thousands of tons of feces are not disposed of properly, polluting water and spreading diseases among women and children.

Every year, 1.8 million people die from waterborne diarrheal diseases. Ninety percent of these deaths are children under five-years-old.

Clean Team Ghana has made it their mission to fix this sanitation crisis. The company has invented an inexpensive toilet service to help low-income citizens.

“People of all ages, regardless of circumstance, deserve the right to perform their necessary bodily functions in safety, without the risk of spreading or contracting disease. Our mission is to ensure as many people as possible can enjoy that right,” explains the company’s website.

Kumasi, where Clean Team Ghana has focused its efforts, is Ghana’s second-largest city; here, rapid urbanization and development issues are rampant. Unplanned slum areas do not have any type of sewer system. Half of the population of Kumasi uses public toilet blocks.

According to How We Made it in Africa, public toilet blocks are “often over-burdened, poorly maintained and unhygienic. Those that cannot brave the stench would prefer to do their business openly–or in packets that are then thrown into gutters, polluting water supplies and causing diseases such as cholera.”

Families without proper sewage can rent out Clean Team Ghana’s portable toilets, which the company installs and treats three times per week, exchanging the used canister for a fresh one. The dirty canister is treated at a processing site and reused.

One toilet provides service to five to seven people, and only costs $2.50 to install. The service costs a family $8.90 a month for one toilet. Clean Team Ghana offers weekly payment services, as very few customers earn monthly salaries.

“Most of our customers are traders and earn daily sums of money, maybe even weekly sums. So we have account managers who visit these customers at least once a week so they can pay in bits,” said Clean Team Ghana CEO Abigail Aruna.

The toilets are odorless: the company uses chemicals to mask the smell. They do not require water or pipes, only some space.

So far, Clean Team Ghana has installed over 1,000 toilets across Kumasi. The company aims to install 1,500 more by the end of 2015. Clean Team Ghana markets their toilets by going door-to-door in settlements and explaining how the toilet works.

Aruna believes that in the next few years, Clean Team Ghana can install 10,000 toilets in Kumasi. Once they reach 10,000, the company plans to expand to other cities in Ghana.

“Research is ongoing around that. There are regional differences and we will take them into consideration before we expand. The situation in Kumasi is quite different from the situation in Accra or in Tamale, or in other towns,” explained Aruna.

Clean Team Ghana began when the nonprofit Water and Sanitation for the Urban Poor partnered with Unilever, a company that produces cleaning agents. designed the toilets, and at the beginning of 2012, the project was funded by the Stone Family Foundation and the Bill & Melinda Gates Foundation.

“Innovative ideas like ours are really necessary in Ghana and other African countries that cannot afford to put adequate sewage systems in place in their towns and cities. So I think the future of Clean Team Ghana and other sanitation companies is very bright–and is a way forward to solve the sanitation issues in Africa for now,” said Aruna.

Margaret Anderson

Sources: How we made it in Africa, Clean Team Toilets
Photo: Core 77

Currently, approximately 2.5 billion people around the world do not have access to basic sanitation services, according to the World Health Organization (WHO).

On November 19, the UN released a report highlighting the gaps in water and sanitation progress. “Water and sanitation are essential to human health. Political commitment to ensure universal access to these vital services is at an all-time high,” said WHO Director of the Department of Public Health and the Environment, Dr Maria Neira. “International aid for the sector is on the rise. But we continue to see major financial gaps at the country level, particularly in rural areas.”

Ninety-four countries were surveyed in the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water report. Data revealed that over 80 percent of these countries have enacted national policies for drinking-water and sanitation, with over 75 percent enacting policies for hygiene as well. The report also recognized that international aid for improved water and sanitation conditions is increasing. Aid rose from $8.3 billion to $10.9 billion between 2010 and 2012- an increase of 30 percent. Most recent increases in international aid have been the result of strives toward the Millennium Development Goals.

However, WHO points out the major gaps in the MDGs. Approximately 748 million people lack access to clean drinking water sources while a billion people have no sanitary system in place and are forced to practice open defecation.

Still today, hundreds of millions of people lack clean water and soap to wash their hands. This leads to transmission of diarrhoeal disease which is the second largest killer of children under five. Lack of clean water can cause many other water-borne diseases as well, including cholera, typhoid and hepatitis while poor sanitation can cause debilitating diseases like blinding trachoma, intestinal worms and schistosomiasis.

WHO reports that the key obstacles which inhibit progress to water and sanitation development include insufficient funding and weak national capabilities to carry out water, sanitation and hygiene (WASH) initiatives. While statistics show that international aid is increasing, 80 percent of countries have declared that their current financial resources are too low to meet WASH targets.

The funding gap is even more extreme in rural areas which represent the majority of people in need of sanitation and water systems. According to the new report, less than 10 percent of WASH financing goes to improvement in rural areas. Additionally, the report cites challenges in implementing WASH programs in national institutions like schools and health facilities. Fewer than 30 percent of surveyed countries have institutional WASH plans that are being fully carried out, funded and reviewed.

Despite these obstacles to WASH and Millennium Development Goals, many are still hopeful that countries will get back on track to achieving their targets.

“Now is the time to act,” says Michel Jarraud, Chair of UN-Water and Secretary-General of the World Meteorological Organization. “We may not know yet what the post-2015 sustainable development agenda will look like. But we do know that water and sanitation must be clear priorities if we are to create a future that allows everyone to live healthy, prosperous and dignified lives.”

 – Meagan Douches

Sources: UN, UNHCR, WHO
Photo: U.S. Chamber Foundation

cambodian toilet crisis
A Southeast Asian organization has used simple economics to create an effective solution to the Cambodian toilet crisis.

The Ministry of Rural Development reports that 61.4 percent of rural Cambodian households lack toilets. Open defecation has been proven to cause diarrhea, malnutrition, stunted growth and negative impacts on a child’s cognitive development.

However, according to a water and sanitation report published by The World Bank, more than half of the Cambodian households that lack a latrine could, in actuality, afford one. With current awareness and subsidy campaigns, latrine coverage has been increasing by only 1.3 percent per year, which means it could take more than 60 years for Cambodia to be “Open Defecation Free.”

WaterSHED is a Phnom Penh-based organization, founded in 2010. This humanitarian team works on water and sanitation marketing in Southeast Asia. The founders of this agency discovered that building toilets in Cambodia was outlandishly expensive. The price to build and assemble a toilet was between $250 and $400, but with Cambodia’s GDP per capita at around $950, having a toilet has been traditionally reserved for the wealthy.

Using a supply and demand framework, WaterSHED toilet suppliers lower their prices, increase their volume and offer a complete package including toilet installation for only $45. Families can pay for these latrines with microfinance loans targeted only at the very poor.

With this new method WaterSHED has reported the sale of 75,000 toilets in 59 of Cambodia’s 171 districts. This rate of toilet installation increases the annual coverage rate up to 7 percent.

The impact of WaterSHED’s advocacy has seen visible results. IRIN, a humanitarian news agency affiliated with the U.N., interviewed citizens in the Kompong Speu Province. In this village of 160 families, around 100 have recently installed a new toilet. The families have already seen the health benefits of their new latrines, including less frequent fever and diarrhea.

The World Bank argues that making the elimination of open defecation a top priority for policy makers in Cambodia is crucial to the productivity of the next generation. With innovative programs like those implemented by WaterSHED, the future looks brighter for the youth of Cambodia.

— Grace Flaherty

Sources: IRIN News, World Bank
Photo: Flickr