Friday 29 May 2015

What Norway & Co. are doing for health sector in Nepal ?

By: Bikal Dhungel

Norway is one of the wealthiest countries in the world. It is a major exporter of Oil and Gas and is rich in other natural resources. Despite being a welfare state, it maintains highest living standard in the world and ranks highest in Human Development Index (HDI) for the last 6 years. Norway is not the part of European Union (EU) but of European Economic Area (EEA) and maintains its weight in international community especially as a part of the United Nations and North Atlantic Treaty Organisation (NATO). Norway not only homes the Nobel Committee which awards the Nobel Peace Prize, but also acts as one of the mediator of Peace.

Norway brokered Israeli-Palestinian peace deal, so called ‘Oslo Accord’, it involved actively and helped to end the bloody civil war in Mali in 1995 and Guatemala in 1996. Some news agencies also report that Norway is involved in mediating peace with the Taliban. These efforts show that Norway is genuinely interested to solve worldly problems and continues to be a part of humanitarian missions throughout the world.

In addition to this, Norway is one of the most generous donors of Development Aid. It is one of the few countries that have crossed the threshold of 0.7% of GNI for Development Aid to reach the MDG. Norway provided highest amount of ODA in terms of percentage of GNI in 2013 ( OECD, 2013). In Nepal, Norway is one of the most important partners in health sector. Nepal is one of the speciality area of Norway. Since two decades, Norway established itself as a generous donor who among others supports the peace process between the Maoists and the government and involves in other issues related to it. In addition to the role of Norway, I will also highlight what other organisations or foundations are doing. The role of international actors in the health sector of Nepal cannot be ignored because the recent development in health sector was phenomenal but this was not only due to the achievement of health authorities in Nepal but most credit goes to international donors like Norway, Unicef and others. Thanks to their financial and technical support, Nepal increased its life expectancy by more than 12 years in two decades. In the year 2014, an average Nepali lives more than 70 years according to a report published in renowned journal, the Lancet.



All the data for this article was taken from the statistical database of Norad (Norwegian Aid Agency ) by the author. 

This figure shows total Norwegian Aid to Nepal in million Norwegian Kroner. It shows that from the year 2000, total aid was continually increasing until 2006. After 2006, there was a decreasing tendency. During the Financial Crisis of 2007 and 2008, total Norwegian Aid to Nepal also remained lower than the level of 2006. However, the year 2009 saw an increase which remained constant until 2011 and afterwards, moved downwards reaching below 200 million in 2013.


When we just look at the health sector in the figure below, it shows total Norwegian Health Aid to Nepal in million Norwegian Kroner. From 2000 to 2002, total amount was somewhat constant.  However, the year 2003 faced a dramatic reduction by more than a half but again a year after this amount was taken the same level as of 2002. It again stayed constant until 2006 but then dramatically decreased to less than 20 million and stayed at the same level until recently. 


 Similarly, when we compare the contribution of Norway in health expenditure, along with other south Asian partners, we will discover that Nepal gets more support in average than any other south Asian country. It remained between 1 to 3% of total expenditure from 2000 to 2006 but then decreased. 


And the table below shows the total expenditure in health by the countries themselves in billion US$.


Here again the number just for Nepal


Analysing the financial support by Unicef in South Asian Region, it becomes clear that Nepal is getting the most support. The figure below shows the Unicef support in million US$ from 2005 to 2012. 

(Data accumulated from Unicef Statistics)

Globally, the Unicef is an important player. The figure below shows the global health aid by Unicef. We see a decreasing trend from 2010, probably due to the lower amount of funding they receive from countries due to financial crisis. 


 The figure shows the annual grants of Bill and Melinda Gates Foundation for health. At the end of the tail, it also shows a decreasing trend. It might also be the decrease in the endowment of the fund. Financial crisis hit the businesses as sell will be lower. However, this is just a guess, can also be wrong why there is a decreasing trend.


Thanks to the great efforts from international bodies, health status of poorest countries like Nepal is improving. Only one figure is enough to tell the whole story, the life expectancy. Life expectancy is connected with various factors like improvement in healthcare facilities, medical infrastructures, increase in nutritional levels or calories, health related education etc. When things improve, people live longer. The life expectancy also increases when infant mortality rate decreases. Infant mortality rate again is connected to various issues like medical infra-structure, nutritional level of the mother, education of the mother and general health awareness. With the two figures below, I would like to end this article by thanking the international community especially organisations for their precious support. 

Why inequality matters and the limits of Gini-coefficient


By: Bikal Dhungel

There are already few articles about inequality in this blog. In one I dealt about the educational causes of inequality and in others the status of inequality around the world, historical causes and so on. This article will focus on why inequality matters for us and what are some of the drawbacks of inequality measurement tool called Gini-coefficient. Why I combine these two issues is because Gini-coefficient can be misleading, it might not represent the real world issues of inequality and biased data might arise which is likely to induce wrong policy.

To answer the question of why inequality matters, it is worth rewinding the origin of inequality quickly. There are basically five reasons of inequality.

1) Luck and the starting point – Luck is one of the most important determining factors of our success in life. If we are lucky and were born to rich parents, our likelihood of having a better life is higher. In the contrary, being born to poor parents or in a poor country, we are less likely to succeed or face difficulties in various aspects of life. For example, studies on inequality have shown that being a woman means earning 21% less in average. Being a Bangladeshi or black African in the US would mean that you will earn 20% less in average. Being a white and male would mean that you will earn more. You don’t determine yourself either you will born to whites or blacks or Asians or South Americans. You luck, which means, you didn’t choose to belong to a particular group will have a huge impact in your life. Hence, it is one of the most important factors that will determine inequality.

2) Childhood and early life opportunities – It is little bit related to the first point but not fully. It is not necessary to belong to a rich family. Also when we are in a country that at least guarantees us education, health and equality of opportunities, this will predict our better future. A child born in a family that is not really rich but can afford these things, children will earn more in the future than those who did not enjoy such privileges. Hence, the inequality between them will rise. This is why, in countries that guarantees all its citizens with free education health and opportunities are more equal than those that could not guarantee.

3) Global Factors – We live in a globalised world. We are more globalised than any time in history. But globalization is not without faults. A detailed account of this has been written on Joseph Stiglitz's book 'Globalisation and its discontents', but also in many others. One major criticism of globalization is, it has accelerated the increase of inequality. Firms internationalize and though it might have increased the total employment rate, inequality has increased. Moreover, the rise of so called 'Emerging Economics' like China, Brazil and South Africa has increased inequality. Here exactly I would like to mention why I incorporated the issue of Gini-coefficient. Though the rise of emerging economies has increased inequality, this might not be necessarily bad for us. But we will discuss this later. Then there is the issue of trade liberalisation and economic liberalization of national economies. This include deregulation, free trade etc which will help some industries to grow but there are also losers of free trade and globalization in practice. Once there are additional firms operating within a country, there will be a shift of labours from agriculture to manufacturing. This will contribute to growing inequality as well because the productivity of manufacturing is higher than in agriculture. Hence, those working in agriculture will be more unequal in comparison to industrial labourers.

4) National Economic Form – The form of an economy determines the degree of inequality. For example, if 20% of the economy consist of financial sector and the remaining agriculture, the income of this 20% will be very unequal than those working on fields. In an agricultural economy where largest portion of the population is subsistence farmers, there will be high equality. Accordingly, we can differentiate how many percentage of the labour force are engaged in manufacturing or agriculture of service sector to predict inequality. Levels of unionization also play a role in it. Trade Unions bargain wages for the workers and avoid their misuse and ensure that the workers get decent wages for living. This will reduce inequality. Countries with strong trade unions are typically more equal than those without.

5) Tax Policy – Though there are capitalist class, labour class, rich and poor and high inequality, an appropriate tax policy can reduce inequality. A more progressive tax policy will reduce inequality because in this system, the more you earn, the more you pay as tax whereas in the regressive system, the richest get tax breaks or pay less. When the richer class is also the lawmaker, they would bring policies that are better for them. One can look at the US. President Bush for example is a business man. There are many senators who are business tycoons. Hence they fight for less government, more tax reliefs for big corporations etc. Consequently, inequality will remain higher. In Western Europe where there is predominantly progressive tax system, the rich subsidises the poor and inequality is lower. So, the form of tax policy in a given country will contribute to the level of inequality.

Having a close look at the origin of inequality, it will now be easier to analyse why inequality matters. First is the economy itself. Imagine a country with a regressive tax system that grants tax reliefs for the ultra-rich and pressures the poor. In such system, tax collection will be lower. With lower tax collection, they can invest less in education, infra-structure, health and other sectors that are fundamental to raise the living standard of the poor. By failing to grant this, the poor will remain poor and the rich will get richer and richer. This will affect the economy in long term as most talents go wasted, a phenomenon we see in a typical developing country. The cause of financial crisis lies in such culture. The ever widening divide between the rich and poor can fuel societal violence which we see in the form of street protests all over the world.

The rich reside in a wealthy neighbourhood whereas the poor will move to the ghettos and go to school there. This causes a social divide and their chances of rising up remains low. The distance between the people will be larger and at last result in even more inequality. From the argument, we can say that inequality impede equity and social mobility in the long run.

Bad health is another consequence of inequality. The book called 'Price of inequality' by Joseph Stiglitz gives a detailed account of the impact on health. Status anxiety has become a normal problem recently which contributed to ill health of people. The famous 'Glasgow Effect' shows this in a creative way. Two parts of the city of Glasgow, one rich and another poor have different health indicators. In rich part, normal citizens live and in poor part, most drug addicts and people on benefits. The rich live 77 years on average whereas the poor less than 65. And then border of these two areas, it can be observed, if you live 10 meters away to another street, you will live 77 years on average and if you live in the poor side, your life expectancy will be well below 70. Inequality will have negative effects on health.

I gave the example of regressive tax form where the rich pay lower taxes. Another consequence of having rich individuals is they can have tremendous influence on policy making. The rich sponsor the political campaign for a certain politician and once he is elected, he will give his best to bring laws that favours the rich. The rich then give their best to avoid redistribution of their wealth. Hence, a just policy is endangered. There will be a democratic deficit when the laws are made by the rich to fulfil their own interests which are against the will of the poor. The matter of justice is itself a problem. When a government is not spending on our children, inequality will be transferred to their generation and further and further. This is simply not right. Inequality is morally wrong.

Evidences from developing countries show some psychological effects of inequality. We live in a society. We compare ourselves with people around us. How much we have achieved, how much money do we have, how many houses we have etc. It is a natural phenomenon to compare ourselves with people. But sometimes we cross the limit to show up. Even we cannot afford a motorcycle, we buy it just to show our neighbours or friends. Having done that, we are ignoring our other needs.
When a person is struggling to fulfill the basic needs of his family but buys a motor cycle will have to abandon things that are necessary. People even fall into debt to finance this. Hence, the presence of inequality will cause negative societal effects.

We live in a world of over 7 billion people with three billion extreme rich , 1 billion extreme poor and the remaining marching towards the rich. The rich and those marching towards them are consuming goods at a rate that earth alone cannot sustain. Researchers say that 4 other Earth is required to keep up with the pace. In addition to this, food waste is a serious problem in richer world, and of course obesity. This caused an immense burden on the planet. Inequality resulted in overconsumption in one part and mal nutrition in the other. Again, ths means a waste of talents of those who are not being able to bring it out.

Looking at some real world example, places where there is very high inequality, namely South Africa, India, few countries of South America, there is high political and economic instability. In order to avoid any violence, they invest heavy amount in security, in police and army. The crime rate ig higher and for the rich, it is difficult to secure their property. As a result, many rich have brought their wealth to safer countries impacting the economy of places where they are from. In such a scenario, both rich and poor are affected. That is why, inequality is bad for everybody.

Now let us move to the measurement of inequality, the Gini-coefficient. Before we start, let us underline again that inequality per se is not bad itself rather the particular kind of inequality that is bad. The Gini-coefficient measures the inequality among and between nations that gives us a framework for analyzing. But our analysis based on Gini should be carefully dealt as there are many issues that Gini doesn’t and cannot answer. So, let us begin with a short introduction of what is Gini co-efficient.

Gini Co-efficient and the limits of it

Gini-coefficient is the measure of income dispersion. It shows the difference between the rich and poor which we call inequality. When you read that a Gini of a country is 0, it means there is perfect equality and a Gini of 1 means highest inequality which implies that one person has all the wealth and another has nothing at all. In some cases, Gini can even go higher than 1, when the income is negative for example. Many organisations use in the form of 0 to 100 as well but it is the same thing when we convert. A Gini index between 0.24 and 0.5 can be regarded as normal and above that, one can say that the society is unequal. The statistical data shows that in fact, African countries are most unequal since most of them have Gini above 0.6. However, it is also important to see before tax and after tax Gini index. A country can have a Gini index of 0.7 before tax (highly unequal) but due to better taxation, the income will be redistributed which will lower the inequality hence moving the Gini index downwards. Statistics shows that Latin America has the highest Gini after tax. It shows that inequality and tax systems are not pro poor there. The graphical representation of Gini could be done with the help of Lorenz Curve which shows how much wealth does the bottom 10% of the population possess, how much the next 20% or 10% or so do. When the curve is 45 degree, it means that bottom 10% possess exactly 10% of wealth, top 20% will possess exactly 20%, meaning everything is equal. Lower the curve goes in the middle, higher the inequality.

Until now, we talked about the Gini-coefficient in general. However, it is necessary to be focused and apply Gini-coefficient in wider area. For example, the Gini-coefficient of education, Gini of Opportunity, Gini of social mobility etc will give us a better picture about where the problem lies. If we only focus on income inequality and try to fight for the cause, we might end up worsening the situation of a country because income inequality can also rise when one person works really hard and the other doesn’t work at all. Bill Gates and Steve Jobs didn’t inherit their wealth, they worked hard for it, they spent lifetime learning and at last made so much money. Though they possess lots of wealth and drove the inequality index higher, this is not necessary a bad thing. We all profit from their idea and innovation.  That is why we should see the Gini of education and opportunity here, either everybody else had the same education levels or opportunity as Gates and Jobs.

Many newspaper articles and some academic journals have based their research on the data represented by Gini-coefficient to explain the issue of inequality. However, careful examination is required. Let us start from developing countries for example South Africa which has among the highest Gini index. While Gini index has risen, the number of poor people has in fact decreased. This is because the rich are getting richer in a higher pace than the poor. Growth of income of rich is growing at the rate of 10% annually whereas the income of poor is growing at the rate of 5%. In this case inequality increased but poverty has decreased. From this fact, we can conclude that Gini is just a relative and not an absolute measure. Moreover, socio economic factors like the population growth, immigration or emigration affects the index as well. Coming back to the relative and absolute numbers, suppose a country has 10 trillion $ wealth and top 10% have 50% of this amount or 5 trillion. Suppose another country which has 10 million $ as total wealth and also the top 10% have 50% of wealth or 5 million. The Gini index of both of them will be same. However, we can easily notice that their wealth is not the same. The Gini index of Afghanistan and Denmark is same but this doesn’t mean that both of them are equal. Denmark is much richer than Afghanistan and when we focus on Gini index of Opportunity or Education, people in Denmark enjoy free education in all levels while people in Afghanistan do not. Similar examples could be seen in countries like Norway where the Gini index is low but wealth is very high.

Mathematically, taking the example of Afghanistan and Denmark, Afghanistan has an unemployment rate of about 50% and the 50% wealth belongs to the remaining 50% of the population. In this case, the calculation of Gini would exactly give a coefficient of 0.5. In Denmark on the other hand top 25% possess 75% of wealth and lowest 75% people possess only 25% of the wealth. Using the formula to calculate Gini index, in this case, Denmark will also have the Gini index of 0.5. So, is it the same? Absolutely not. I mentioned the effect of population growth above. Population growth either by birth or by immigration will affect inequality. Immigrants either come with lots of wealth or very little wealth to work, both will affect Gini index. For example the international students come to Germany, bring their own money to pay for living cost or live in a subsistence level and the inequality within Germany will rise. However, once they finish their studies and enter the job market with above average salary, the Gini will approach to the level it was before their arrival. Calculating the Gini across ages gives us a picture about the inequality of a country but it is normal that people are relatively poor in their twenties when they are still studying or participating in vocational trainings but get slowly richer once they enter the job market. A country with lots of young people, like the developing countries these days will show a high Gini index than a country that has an ageing society like Japan and Western Europe. Which one is good, depends on your analysis. In the same case, when these young people find no job and still get poorer in the long term, Gini falls further. Finally, more than half of   developing countries economy is regarded as informal. There is no monetary value of goods produced, the jobs done in agriculture are not really regarded as jobs which makes difficult to calculate their income and hence the inequality level. A household where the husband goes to work, wife works in the household will have a Gini index of 0.5 but that they share the income equally cannot be taken into consideration and will bias our analysis of inequality measure. Informal economy is hard to measure even in developed countries because there is no data. So, the inequality measures cannot be fully accurate.

Considering all the above mentioned facts, it becomes clear that Gini-coefficient cannot and should not be used as a measure to analyse the inequality within a country. It can be used to gain a quick overlook but the uses of this should be carefully examined before making any assumptions. However, the issue of inequality is a major concern of today that will engage us intensively in the coming decades. The article started with the origin of inequality, explained why inequality matters or why it is an important topic and why it is better to have a just society with fair opportunity for everybody and finally mentioned the limits of the most important inequality measurement tool. I would like to repeat that inequality matters but we should be careful with studying it. The wrong use of instrument will cause fraudulent policy and we all are worse off by this. Hence, to avoid this catastrophe, we need intelligent tools.


Thursday 28 May 2015

Information Economics and Agriculture

By: Bikal Dhungel 

This article will highlight some issues about information economics and the role of information in agriculture.

Normally economics was understood as a science that deals about resource scarcity and how to make an efficient use of given resources. 'Resource' was understood as some object. For example, oil is a resource, coal is a resource, cotton is a resource but information ? Information was not considered as a resource of its own for a long time but since few decades, information is an area in itself that has a huge importance. In economics, it is now a separate discipline, Information Economics, for simple reason which is, the extent information affects the economic decision making and the economy as a whole. In other words, information has value and it helps people to maximize their returns. Take lawyers for example, they make their living by giving people information. The information lawyers have, others dont have, that is why they are ready to pay for this. For this term we call 'Information Asymmetry', which in this case says, the lawyers and the customer have different information. One has more information and the other less. What cause this difference in the amount of information they both possess is the amount of time invested to acquire this information. Lawyers study several years and work several years before they can set up as a lawyer. In this period, they gain expertise. All they have is better information which they use to make money. However, exchanging and acquiring information is not the same as exchanging and acquiring other physical goods because information is non-rivalrous, which means, even if I get some information from somewhere, you can also get it or your getting of the information does not exclude me from getting it. In the case of other goods for example a mobile phone, it is different. When I buy a certain piece of mobile phone from a shop, it is gone, i have it and you cannot buy the same phone. Information is also different from other goods because of its marginal cost. When a company produces mobile phones, for every additional phones, it should spend more money but in the case of information, it can simply copy this or reproduce this with zero cost. I wrote that information is non-rivalrous but in reality in some cases, it can be made rivalrous. Like when you work in a government agency that has published a report on crimes, may be only few people have an access of this. So, one can exclude others artificially but in general information remain non-rivalrous.

We often hear that we live in an information age. So what is this information age ? Information age means, we are overwhelmed by information through various means. When we take internet as an example, we can look for certain things through various search engine, we can check train schedule, we can google through the website of our school and do many things. With the help of mobile phones, we can contact with people, share ideas, exchange information and so on. There are social networks, there are professional networks, there are dating websites, online health check ups and many more. This was meant by information age. When we are able to invest in few devices, we are the part of the information age. Due to rapid transformation of information and communication technologies, more and more people can afford such devices. There are now more mobile phones than toilets in a typical developing country. Why the information is important is because it can increase our well being, in all sectors. This article focuses only on agriculture. The overall influence of better information technologies in all other sectors can be a big topic in itself. Information is needed everywhere. I took agriculture about agriculture is very important in developing countries. It is their lifeline. Over 70% people in least developed countries are farmers and most of them subsistence farmers. They are also the poorest. Hence, improving the lives of farmers through information will contribute to alleviate poverty and generate economic growth. Without supporting farmers, it is not possible to achieve growth.

70% of the world population live in rural areas, most of them in developing countries are subsistence farmers, who are poor and are under threat, either of any natural disasters or climate change. Climate change will affect developing countries over proportionally but even within developing countries, poor are especially at risk. Apart from climate change, a bigger challenge is of poverty. The crop yield is so low that mal-nutrition is rampant in least developed countries. Effects of not having enough to eat will remain lifelong, in terms of lower cognitive skills, risks of diseases and many more. This in turn will push the poor even further in poverty traps. Hence, to pull them out of this trap, the first step it is needed is to increase their daily calory intakes. This can be done by providing them with more foods which again can be done by increasing yields. The United Nations called so called Millennium Development Goals whose first goal to eradicate extreme hunger and poverty. Without achieving this goal, other seven goals cannot be realised. The first goal can be realised though agriculture. It is also necessary to ensure food security which has become a luxury these days. So, a sharp productivity increase in agriculture is vital to ensure food security. However, it is easier said because other challenges developing countries are facing cannot be ignored. The rate of population growth is higher, more living space is required, houses should be built on farm lands, and there will be pressures on other natural resources like water which could be used in agriculture, increasing production itself is resource intensive, especially water. Places that face water scarcity will find tough to achieve this. This is the main challenge we face today, how to maintain this balance, the use of resources and increasing the crop yields. Though there has been extraordinary developments in the past decades concerning biotechnology, information technology, market structure etc, challenges remain. But still, something should be done. Emerging economies like China and few other countries have invested heavily in agriculture in the early stages of their growth. Productivity increased and crop yield also increased with it, which was then able to support the growing needs of people. Though the agricultural growth has increased, the share of agriculture in national GDP decreases. This is a quasi natural phenomenon of growth. The more a country develops, its share in agriculture decreases as people move to industries and then to serives. The higher the share of agricultural GDP, poorer the country. So, when people start moving to industries, inequality also rises in the initial stage but slowly it will decrease. As productivity per worker increase, due to technology, a household where 5 people worked in farms before, now need just three, then the two will go to the city to work somewhere else. By this way economic growth occurs. As productivity increases, less and less people are required in agriculture and slowly, the total number of farmers will approach to 0. this is also the difference between three worlds. In poor world, mostly over 70% of the working age group involve in agriculture, in the middle income group, it is between 4-20% and in rich countries, mostly less than 4% as in the case of France or even less than 2% like in Germany. So, the question arises, how can we reduce the proportion of farmers or in other words, how can we help the farmers to increase productivity so that they come out of poverty trap and contribute to the economic transition of a nation. This is where the role of information is needed. With information and information technology, it would be possible to accelerate productivity growth.

When we talk about agriculture, it is not only growing crops, the role of a farmer is much wider. So, when we say using information to enhance productivity, it means the whole food chain i.e. Using information in cultivation, water usage, fertilizer uses, harvesting, transportation of crops or foods, packaging, preservation, processing, quality management, safety, storage, marketing and when applicable, disposing. Innovation with information in all these things can enhance agriculture. All stakeholders of agriculture would profit from the availability of information. So what are these information exactly that helps ? The need of information varies between the stakeholders. Cultivators would need different types of information than those in marketing. The variety of information can be for various purposes, like

  1. Office Automation – application of telephone networks, computers and other telecommunication technologies in order to increase the productivity or organisations. Both public and private sector can help in it to provide a better service in agriculture to facilitate rural development. This includes the use of machines in government offices in both national and local level, uses in small farms and firms which will strengthen the process.
  2. GPS System – GPS or Global Positioning System revolutionised our age, its uses are wide and benefits huge. In agriculture, it can be used for making maps, doing surveys and it even provides the benefits of geo-fencing. There is an interesting Ted Talk about the use of local knowledge where the speaker organised a group to plant tomatoes in one village somewhere in sub Saharan Africa. They didnt consult with the locals. After some time, tomatoes were growing and one night Hippos from the nearby river came and ate away all the tomatoes. Why I mention this story is, animals eating away the crops is a serious problem in developing countries. Lots of effort will be wasted by this way. So, GPS can help to solve this problem by tagging animals which will enable them to see where this animal in roaming right now. By this way one can avoid the animals wandering in the farm and squandering the crops.
  3. Geographic Information System, GIS – this will enable us to digitalize the land maps using the data and help us to make better decisions about what and where to plant using the data from the past. In general, GIS is better to store, analyze and better manage data which has a wide application in agriculture. The world food program writes that GIS methodology will help to understand the vulnerabilities among population residing in areas that are prone to natural disasters as the analysis could be done considering natural hazards, environmental disasters, degradation, food insecurity etc. The satellite images will help to analyze the poor growing seasons which can be used to plan an intervention by the authorities to support vulnerable groups. Moreover, it will contribute to the research related to agriculture and environment.
  4. Computerized Devices for Research – We have arrived very far in terms of human medicine, we have also developed a certain degree of knowledge about animals, about their behaviors and diseases but we have a long way to go. Most deadly diseases we face today, for example malaria, HIV and the violent killers of the past, namely Plagues have its origin in animals, that killed many people. Since the end of hunting and gathering society, we are literally living together with domestic animals, and also sharing their diseases. We have little understanding about how animals acquire diseases, how their foods affect their health which in turn affect our health. Herd management software can for example help to analyze the effect of animal feeds on disease, or milk yields or similar. Analyzing the effect on milk yield, it would be possible to maximize the yield producing higher benefits. This information should be shared nationwide so that the gain will be higher. Individual farmers will obviously oppose this because they would prefer to increase profits by higher yields. But when it is done nation wide, the nation as a whole profits. So, a cooperation between private and public sector will generate better outcome.
  5. Radio Frequency Identification ( RFID ) - It would help in tracking the livestock which is already in use in advanced countries. For example every cattle is tagged with RFID technology which can be used to identify it. More data can be recorded for example bearers location the origin of the cattle, age, sex etc. This will help the farmers and researchers in optimizing.
  6. Smartphone Apps – Even smartphone apps will help in agricultural yields. These days even in developing countries, farmers are carrying mobile phones. They can contact the responsible person if they have any queries like how to cultivate certain crops, what to do when there are problems. They can either ask other people or can look at it themselves. The source of information in informal economies are mostly neighbours and surrounding. ' You know I had used the crop from this place, i did this and this and my tomatoes were as big as pumpkins ', farmers can communicate via mobile phones. The facility of weather forecast for example helps them to plan the day better. The take the raincoat with them to the field, to plan works depending on rainfall and take proper actions in time when it is necessary. Smartphones should not only be used to communicate but also to look for information, share information to increase crop yield and to get better prepared for risk.


These are few information technologies that can help farmers to increase productivity, crop yields and finally reduce poverty. There are other devices that can help anywhere in the agricultural chain between cultivation and disposal. It is only necessary to identify proper steps where an intervention can be useful. The use of information can revolutionize our generation if only the responsible stakeholders play their role efficiently. Governments in poorest countries should acknowledge that farmers in the first hand will not be able to take part in information age without support. They should be taught to do this. Using the modern ways of teaching, like drawings, photographs, audio, video and other things, farmers should be taught to do things, to use devices and make the most out of it. There should also be a better allocation of market places and a viable pricing system. The challenge of developing countries is also to get the prices right. Farmers produce crops, they bring it to the supplier, sell the crops or vegetables with a price that is only slightly higher than their production cost but that middleman who brings crops to the market takes the most profit. The established system of market does not allow the farmer to bring the crop directly to the market. Using information, this can be changed. In another stage, changes in the way food markets typically work will benefit the general public. The origin tags, expiry dates will help customers to choose foods according to it. Advanced countries have this system in law but poorest countries cannot implement this for vegetables and crops sold on the informal market. Something could be done there. Moreover, there can be more research in food businesses that is sure to induce more food related business people. By the points above, I mean using information to make the food market efficient and especially with the information technologies, we will be able to increase crop yields, decrease production cost and this will reduce food prices and everybody can afford enough foods and this will reduce poverty, increase their physical ability, cognitive ability and contribute in the development of a society. Hence, do not ignore agriculture. Understand the role of information, understand the dynamics of information, psychology of learning and implement information where ever necessary to solve the most challenging problem of our generation, which is to end hunger.  

Monday 25 May 2015

Health Status of South Asian Region

By:Bikal Dhungel

South Asia is the poorest region of the world. The largest number of poor people with less than $1.25 a day live in South Asia. It is also the most populous place where over a quarter of world population live. Stretching from Afghanistan to Myanmar, South Asia is politically unstable with dozens of ethnic and regional conflicts. THe region still has hangover of Colonialism with many places either under authoritarian regime or at least a government which care less about its citizens. Geography remains complex. The himalayan mountain range from Myanmar to Afghanistan complicates development process and the lowlands in India and Bangladesh are vulnerable to rising sea level which is currently under threat. Ethnically it is a diverse region with three big religions, Hinduism, Islam and Buddhism and lots of other groups within it. Poverty is rampant and all countries face the same challenges. This article focuses on health sector and gives a basic introduction in a comparable form in five countries, Nepal, India, Bangladesh, Pakistan and Sri Lanka. 

1 -Nepal

Total population (2012)                                                                            27,474,000                                   

Gross National Income per capita (PPP international $, 2012)               1,470

Life expectancy at birth m/f (years, 2011)                                                  67/69

Probability of dying under five (per 1000 live births, 2012)                       42

Probability of dying between 15-60 years m/f (per 1000 population, 2011 183/157

Total expenditure on health per capita (Intl $, 2011)                                    68

Total expenditure on health as % of GDP (2011)                                           5.4

(Source: World Bank, 2013)

Nepalese health expenditure per capita in 2011 was a meager 68$ which is much less than sufficient. However, in terms of total expenditure on health as % of GDP was 5.4% which does not deviate from the expenditure of most developed countries. A 10 year long Civil War destroyed many infra-structures and that drove the country back to many years and impeded further developments.  

Other challenges like the lack of finances, scarcity of skilled health workers and disease burden exists. As a consequence of 10 year long civil war that caused 14,000 deaths and 200,000 internally displaced people, and other difficulties, Nepalese government needs international support. However, Nepal achieved a milestone in health sector since 1990. The absolute poverty which is one of the most important factors for poor health, has decreased from 42% in 1996 to 25.4% in 2009 (Source: FAO). Nepal has emerged as one of the few countries on track to meet MDGs related to reducing maternal and child mortality and making progress on hunger, eradication of HIV/AIDS, malaria and other diseases (USAID). Life expectancy has increased from 48 years in 1980 to 68 in 2012 (World Bank). The following figures show improvement in other health indicators. 


( Source: WHO Health Profile, Nepal, 2012 )

Out of a GDP of 18.7 billion(2010/2011), remittances comprise of 25-30% and foreign aid represents 26% of national budget (Source: Development Gateway website).  The following figures show that out of total aid disbursement of $ 1.08 billion, 129.6 million are for Health or roughly 13% of total amount. UK, Japan, India, US and Norway are the top bilateral partners.


2 – India

Total population (2012)                                                                      1,237,000,000                                                                                                                       
Gross National Income per capita (PPP international $)                  $4307 

Life expectancy at birth (years, 2012)                                                 66 

Total expenditure on health per capita (Intl $, 2012)                         61 

Total expenditure on health as % of GDP (2012)                                4%                                                                      
(Source: World Bank, IMF, WHO data)

India has the 10th largest GDP of the world (World Bank). With 4.7% growth as per 2012, India is second most populous country in the world with 1.23 billion people ( World Bank, 2012 ) India is culturally similar to Nepal. Hence, the life-style and traditions do not vary tremendously. However, India lies more down to tropical region which makes it more vulnerable to diseases in comparison to Nepal. Additionally, India’s population density was 416 in 2012 (World Bank) and this tendency is increasing rapidly. It is expected that with this growth rate, India will become the most populous country of the world. This also means that demand for healthcare will increase. In the absence of current growth rate of 4.7%, the current level of health infra-structures and workforce including additional budget for Healthcare might not be sufficient to support the system. The following figures concludes some of the recent health developments. 




(Figures taken from WHO website) 

Public Health challenges are likely to increase because of India’s increasing urbanization which potentially put pressure on environmental, as well as nutritional requirement resulting in nutritional deficiency, poor sanitation, increasing communicable and non-communicable diseases etc  (Source: Indian Institute of Public Health )

The Table shows the challenges of health sector in India

-          - Accounts for 21% of global burden of disease
-          - High selective gender abortion
-          - One of the five countries with lowest public health expenditure in the world
-     - The unfinished agenda of health system modernization, including high out of pocket expenditure, insufficiency and uneven distribution of staff, service provision and its quality.
-  - Changes in the epidemiological profile, with emergence of cardiovascular and cerebrovascular diseases, metabolic diseases, cancer and mental diseases as first order problems while tuberculosis, AIDS, water-borne diseases and sexually transmitted diseases remain frequent.
Source: WHO ( Country Cooperation Strategy, India 2013 )

Partners of India and main focus area (Source: WHO):
Partners

-          DFID, UK
-          USAID
-          European Commission
-          JICA
-          UNCT
-          UNDAF
-          World Bank
-          UNICEF
-       Global Health Partnerships (eg: Global Fund to fight AIDS, TB and Malaria
-          GAVI
-          Bill and Melinda Gates Foundation
-          Norway India Partnership Foundation
-          Oxfam, World Vision, Action Aid, Red Cross

Main Focus Area

   Implementing International Health Regulation

                          Strengthening Pharmaceutical sector

                     Improving stewardship of Health System

       Promoting universal health system coverage            
 Properly accrediting health delivery institutions          
           Scaling up reproductive, maternal, newborn, child and adolescent health services


3- Bangladesh:

Total Population (2012):                                               155,000,000                                                                                                    
GNI per capita (2012):                                                   2030

Life expectancy at birth: m/f (2012):                              69/71

Total expenditure on health per capita (2012):                68

Total Expenditure on health as % of GDP (2012):          3.6                                                                      
   (Source: WHO Country Info, Bangladesh, 2012) 

Following figures summarizes the basic health indicators of Bangladesh. 



Under-5 mortality was brought below 50 in 2010 from 180 in 1990, stunted children was almost halved and per capita expenditure increased from below 20 to 70 in only 15 years. These basic indicators show a huge improvement in Bangladeshi health sector.
Bangladesh has made considerable progress in recent decades in improving the health of its people. The population growth rate has declined, life expectancy at birth has increased, infant and under-five mortality rates and maternal mortality ratio have decreased, and a demographic transition is beginning to emerge (WHO)

One of the major causes of death, Malaria is also decreasing in number however, challenges remain. However, Bangladesh is prone to natural disasters such as floods and cyclones that lead to outbreaks of communicable diseases. During the floods of 2004, more than 400000 people suffered from different diseases in the aftermath and required treatment (WHO). The health system must be strengthened, both in terms of its preparedness and response capability, to cope with this scale of emergency. 

Bangladesh is especially vulnerable to cyclones because of its location at the triangular shaped head of the Bay of Bengal (Source: Nat Hazards), the sea-level geography of its coastal area, its high population density and the lack of coastal protection system. About 40% of the total global storm surges are recorded in Bangladesh (Source: WHO Bulletin)

Major challenges of Bangladesh’s Healthcare (Source: WHO)
-          Combating major communicable diseases
-          Containing the increasing the trend of major NCDs and reversing the trend
-          Ensuring equitable and sustainable access to safe water and sanitation, and promoting environmental and occupational health.
-          Strengthening epidemic alert, emergency preparedness and response
-          Strengthening human resources for health development

Major partners in Healthcare (source: OECD)
-          World Bank
-          Asian Development Bank
-          Germany
-          Netherlands
-          Canada
-          Japan
-          Sweden
-          Switzerland
-          IFAD
-          USA
-          Denmark
-          Norway
-          Australia

4- Pakistan:

Total Population(2012):                                                                                       179,000,000

GNI per capita ($PPP, 2012):                                                                              2880

Life Expectancy at birth m/f(2012):                                                                       64/66

Probability of dying under five (per 1000 live births, 2012):                                    86

Total expenditure on health per capita($, 2012):                                                     91

Total expenditure on health as % of GDP (2012):                                                   3.2
                                                                                                
(Source: WHO Country Statistics, 2012)

Following figures summarize basic health indicators. 


Even though child mortality rate decreased from 1990 to 2010, number of children stunted didn’t change from 2000 to 2010. It has slightly increased at that time.
Lying on the laps of Himalaya, Pakistan also consists mostly of mountains and hills like most of Nepal and northern India. 32% of the population live below the poverty line. Geopolitical changes, such as the Afghan war and the situation after 11 September 2001, have affected the country significantly. Globally Pakistan has the third highest burden of maternal, fetal, and child mortality according to WHO.  It has made slow progress in achieving the Millennium Development Goals ( MDGs ) 4 and 5 and in addressing common social determinants of health. The country has huge challenges of political fragility, complex security issues, and natural disasters. Currently, 50% of the population is below 20, which will mean, there will be 235 million people in the working age group. This increase in population is likely to bring more challenges and put pressure on already overwhelmed healthcare system. Looking back to the history of natural disasters, Pakistan is prone to almost all natural disasters. 

Challenges of Pakistan

-          Efforts in improving MDG related health indicators will not be sufficient to achieve the set target
-          The devolution of the EPI program is having an adverse impact on Polio Eradication and routine immunization.
-          Pakistani women continue to face the risk of limited access to reproductive health services and pregnancy related morbidity and mortality 
                                                                           Source: Brief WHO Country Cooperation Strategy



5 - Sri Lanka

Total Population(2012):                                                                                         21,098,000

GNI per capita ($PPP, 2012):                                                                                6030

Life Expectancy at birth m/f(2012):                                                                      71/78

Probability of dying under five (per 1000 live births, 2012):                             10

Total expenditure on health per capita($, 2012):                                                   189

Total expenditure on health as % of GDP (2012):                                                    3.2
                                                                                
(Source: WHO country statistics, Srilanka, 2012)

Following figures gives basic introduction of health indicators. 




( Source: WHO, Brief Country Information, Sri lanka )

Srilanka is an island nation below India which lies on the indian ocean and is prone to natural disasters like cyclones and tsunami. The Tsunami of 2004 caused 31,000 deaths and 4000 missing and more than half million became homeless (Source: WHO). Srilanka achieved great success in areas of health, education, nutrition, despite their low per capita income (The Lancet). However, due to a long conflict between two major groups Tamils and Singhalese, Srilanka faces a difficult challenge for a sustainable development in health sector.
5 years ago, government forces in Sri lanka overwhelmed the liberation tigers of Tamil Eelam, bringing an end to a 26 year long brutal civil war that brought a death toll estimated by the UN at 80,000 – 100,000 (Source: The Lancet). Sri lanka has free education without discrimination, up to completion of university education. This contributed greatly to delaying the age at marriage, thereby reducing teenage pregnancies. Education also empowered women and gave them access to electronic and print media which have enabled them to have a greater awareness regarding health. There is also a provision of healthcare services free of charge (Source: Wiley Online Library).

Challenges and Cooperation partners

Challenges
-          Strengthening the stewardship role of the ministry of Health
-          Meeting the rising costs of healthcare in view of the rapid increase in NCDs
-          Improving use of primary care facilities
-          Strengthening of information systems, Public Health laboratory services, mental health services
-          Addressing environmental and climate change factors
-          Coordination of private and public healthcare providers
-          Large number of health partners with varied expectations
Partners
-          UN Agencies ( ILO, IOM, UNDP, UNFPA, UNICEF, WFP, WHO)
-          Multi-lateral and bi-lateral organisations ( World Bank, ADB, JICA, AusAID, USAID etc )
                                                     Source: WHO Country Cooperation Strategy, Sri Lanka, 2011 

Hence, it can be concluded that all five nations have similar challenges, they are all dependent on external support and their problems lies not only in health sector but also in other sectors. The spill over of political violence, instability, conflicts, natural disasters and economic downturn  impose a burden on health sector which is currently not in a condition to cope with it. Optimism lies on the possible economic growth in the region led by China and India but till then, there is lot to be done as better health should not only be the consequence of economic growth but it can also impede economic growth.