Category Archives: Wikiprogress Africa

FGM: the Dynamics of Change

This blog, by Wikichild Co-ordinator Melinda Deleuze, is part of the Wikiprogress Series on the Wikiprogress Africa Network. This post provides a summary of the UNICEF report entitled “Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change.” 

When I first heard of female genital mutilation/cutting (FGM/C), I was mortified. Upon reading this UNICEF report, I realized that my previous impressions – that this practice it only occurs in small African villages and affects very few women –  were misconceptions. Only now is reliable data on FGM/C available, giving us a clearer picture about the practice, at least for all 29 countries where the practice is concentrated. The report addresses key questions: How many girls and women have undergone FGM/C? Where is the practice most prevalent? How does this concentration vary within countries and across population groups? 
This WHO report defines FGM/C as “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons,” and the Organization categorizes the procedure into 4 types. In 2012, the UN General Assembly unanimously passed a resolution that banned FGM/C. Twenty-six countries in Africa and the Middle East have prohibited FGM/C by law; however, the legislation has proven ineffective. The practice remains widespread in 24 countries where FGM/C is illegal. 
There is a social obligation to perform the procedure and the belief that if one does not, then the consequences could include exclusion, criticism, ridicule, stigma or inability to find suitable marriage partners. Relatively few women reported concern over marriage prospects as justification for FGM/C, except in Eritrea and Sierra Leone. The primary benefit cited among men and women was social acceptance and preserving virginity.
In the 29 countries assessed, more than 125 million girls and womenalive today have undergone FGM/C, and in the next decade, another 30 million are at risk. There is a large variation in percentages of cut females across the countries. The countries are divided into 5 categories based on their prevalence levels of FGM/C. One in five cut girls live in one country: Egypt.
Variation among regions within a country can be striking, as seen in this map of Senegal (right).
The age at which the procedure is carried out varies across countries. In Somalia, Egypt, Chad and the Central African Republic, at least 80% of cut girls were between 5 and 14 years old. In Nigeria, Mali, Eritrea, Ghana and Mauritania, at least 80% of cut girls were younger than 5. Half of cut girls in Kenya were older than 9 when they had the procedure performed.
Initially, opposition towards the practice focused on health risks, which may have unintentionally encouraged medical professionals to carry out the practice. Traditional practitioners and, more specifically, traditional circumcisers usually perform FGM/C. Though, in countries such as Egypt, Sudan and Kenya, many medical personnel now complete the procedure. In Egypt, for example, 77% of procedures were carried out mostly by doctors, and around half of those procedures were performed at the girl’s home.
Ethnicitystill plays a strong role in some countries, as it may be a proxy for shared norms and values. Also, the practice remains to be a physical marker of insider/outsider status. This graph belowshows the degree of variability in FGM/C prevalence among ethnic lines by contrasting ethnic groups with the highest and lowest prevalence in countries.
Regarding religion, the practice is most prevalent among Muslim girls and women; however, it is also found among Catholic and other Christian communities. In Niger, for example, 55% of Christian girls and women have undergone FGM/C, compared to 2% of Muslim girls and women.
There is also a rural-urban divide, an incomedivide, and an education divide. In Kenya, for example, the percentage of girls in rural areas was four times that of those in urban areas. In most instances, daughters of wealthier families were less likely to be cut. In terms of education, the prevalence of FGM/C was highest among daughters of women with no education, and tends to diminish considerably as the mother’s educational level rises. The reason given for these trends is due to the fact that those in urban areas, in wealthier households, or with a higher educational level are more likely to interact with individuals and groups that do not practice FGM/C, shifting normative expectations around FGM/C as a result.
Supportfor the continuation of FGM/C varies across countries. In most countries (19 out of 29), a majority of girls and women think the practice should end (see graph below). Nevertheless, more than half the female population in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt think FGM/C should continue. More men than women favored stopping the practice, especially in Guinea, Sierra Leone and Chad. When fathers were included in the decision-making, their daughters were less likely to be cut. 

FGM/C remains a complicated issue, and this reportdoes not give the whole picture; FGM/C is being performed outside these 29 countries, including  in Europe and North America. The fight against FGM/C has just begun. Stronger efforts will be essential in order to transform the cultural traditions and expectations ingrained in these societies. 

Fortunately, this report gives us a better understanding of FGM/C and, more importantly, an evidence base to begin measuring progress in this area. We know there have already been steps forward in terms of awareness, decreased health risks and legislative bans, but now we can track progress inside countries regarding specific population groups, procedures and attitudes. Hopefully, this evidence base will help us be more effective in promptly eliminating the practice.

Melinda Deleuze

*This week’s Wikiprogress spotlight is on the e-Frame Net (European Network on Measuring Progress).  

Service Delivery Indicators Initiative: Monitoring Health and Education performances in Africa

This blog, written by Ousmane Aly Diallo, is part of the Wikiprogress focus on its Africa Network*.

After pilot tests in Tanzania and Senegal in 2010, the World Bank in partnership with the Kenya Institute for Public Policy Research andAnalysis (KIPPRA)launched the Kenyan Service Delivery Initiative (SDI) on 12 July  2013. The initiative aims to assess the performance of Kenya in the domains of education and health and more importantly to determine if what is spent on these domains is reflected in human development outcomes.

Better monitoring of policies with reliable data
For some time now, the lack of reliable data and statistical capacity has been a problem in accurately establishing the progress in well-being as well as the impact of government policies in many African countries (read more). It has also been a priority for international organizations (See the Paris21’s NSDS Initiative as an example of strenghtening statistical capacity in developing countries). The SDI is meant to help governments determine what is working in their national educationand health systems, where readjustments are needed and what has to be re-thought completely.
Basically, the SDI gives surveys to health and education providers in the host countries. Three main variables are present in theses questionnaires:
  • education and Health Provider’s Abilities (What do they know?);
  • their effort (What do they do?); and
  •  the Availability of Inputs (What do they have to work with?). 
In Kenya, around 5,000 health practitioners and the education staff in 600 facilities were surveyed for the first SDI (here). The results show that public and private school teachers have the same likelihood of working, but those in the public sector are 50% less likely to be in a classroom teaching students. This is mainly due to the public school system having 20 days of teaching fewer per term. Also, only 35% of teachers showed a mastery of their subjects. When campaigning for basic education and attaining the parity between girls/boys in primary school, the low level of teachers’ mastery is disappointing. Reinforcing the skills and mastery of teachers thus appears as important of an element as is children attending school.

In the health sector, over 29% of health providers were absent, and 80% of those absences were reported and sanctioned. Furthermore, only 58% of public health providers could diagnose 4 out of 5 common conditions such as diarrhea with dehydration or malaria with anemia. Additionally, the health providers used  less than half of the correct treatment actions to manage maternal and neonatal complications, and key drug availability for mothers remains a challenge (here). The latter result is particularly revelatory, since maternal health is one of the main health concerns in Africa. Therefore, knowing where the system fails is a step towards overcoming the barriers towards improvement.

Being able to have this level of data is one of the SDI’s main points since it gives a snapshot of what is not working and where the focus should be placed.

Assessing the synergy between well-being and expenditures.
“We cannot manage what we cannot measure. We count what we value”. The initial reason for the deployment of the SDI can be traced back to this phrase. Although a substantial part of their budget is spent on education and health, the expenditures have not kept pace with the population’s needs in most African countries. The World Bank estimates that developing country governments allocate, on average, a third of their budgets to education and health (read more). In a context of economic downturn and growing demand for transparency, assessing what teachers and help practitioners do in an average workday how well they are equipped and how they can be helped is a step towards higher societal well-being. Schools and health facilities are, more often than not, ill-equipped in terms of their infrastructure (particularly in rural areas) and competences. Additionally, in the fields of education and health “(…) if one considers the level of public funds invested in the process, then the glass becomes half-empty in the sense that a great deal of resources have been wasted in pushing reforms beyond what the existing capacity can command” (See here page 9).
The SDI is meant to help capture what is the cause of this discrepancy, determine how health practitioners and education providers are performing and establish corrective actions if need be.

Service Delivery Indicators and Open Data
One of the main contributions of the SDI is the provision of accurate data regarding the quality of education and health services to both decision-makers and citizens. Furthermore, since it is an Africa-wide initiative, it will help improve the quality of these services through comparisons and taking advantage of what has been done in high-delivery countries. The standardization of the indicators allows comparisons between states and sub-national entities. Sub-national regions with poor education and health infrastructure stand a better chance of seeing the quality of services being improved with the SDI Initiative.

Since the surveys are meant to be redone on a biennial basis, progress in this domain can be easily witnessed and monitored.

Transparency of public expenditures and accountability of governments to their citizens are likely to be two of the externalities of this initiative. The African Development Bank recently launched its Open Data Platform for Africa, which gives useful data on well-being and development issues for the 54 African countries, while giving flexibility and leverage to the user. These two initiatives give a better view of what needs to be done by  the policymakers and the citizens, as well as by the NGOs and international organizations. What matters to citizens and how to foster their well-being will be even more evident with this initiative.

Ousmane Aly Diallo

*Wikiprogress Africa Network aims, to provide a platform for knowledge sharing on measuring progress in an Africa context.

WIR Africa: land grabs; FGM/C; MDG Report; tropical disease

This Week-in-Review is part of the Wikiprogress Series on its Networks, highlighting Wikiprogress Africa.

Hello everyone and welcome to another Africa-themed review of progress articles, reports and initiatives. Among this week’s highlights:
  • Securing Africa’s Land for Shared Prosperity. This World Bank publication on land administration and reform in Sub-Saharan Africa provides simple practical steps to turn the hugely controversial subject of “land grabs” into a development opportunity. Poor land governance perpetuates and traps people into poverty, according to the report, which stipulates a ten point program to scale up policy reforms and investments in a way mutually beneficial to land owners and investors.
  • Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change by UNICEF shows that female genital mutilation/cutting is a declining phenomenon globally. Teenage girls are less likely to have been cut than older women in more than half of the 29 countries in Africa and the Middle East where it is concentrated. The paper identifies intriguing trends in who is performing the cutting, the severity of it and people’s attitudes toward it. Extracting data from the report, the Guardian produced an interactive map of female genital mutilation/cutting, showing where in the world it is most prevalent and what the main variations are between countries. 
See video below on FGM/C in the Côte d’Ivoire.
Romina Rodrigue Pose, one of the authors, highlights the main points of the report in this blog post 
and shares her personal experience of the field research through this slideshow (below).

Created with Admarket’s flickrSLiDR.
  • The Skoll World Forum asked a handful of speakers their reflections about the timely issues in international development and how they can be addressed. Among them, Mthuli Ncube, Chief Economist of the AfDB, states in this post how governance and country ownership are important for development progress. He argues that there is consensus that good governance should build on effective states, mobilising civil society and efficient private sectors – three factors which are critical for sustained development.
  • How Africa’s natural resources can lift millions out of poverty. In this article, Caroline Kende-Robb, Executive Director of the Africa Progress Panel report, bases her points on the recently released Africa Progress Report 2013: Equity in Extractives. Shestates that natural resources can lift millions of African out of poverty through transparency in the concession deals, tackling tax avoidance and evasion, and inclusion of citizens in the decision-making process. The revenues of these natural resources when spent on education, health and job-creating policies can sensibly improve the quality of life of individuals, as was the case with Botswana, which passed from a poor to stable, democratic and upper middle-income country in 40 years.

We hope you enjoyed this review. Stay tuned the same time next week for another read on the week that was.
Yours in progress,

Open Data for Africa, Youth Participation and Assessing Progress towards the MDGs

This blog, written by Ousmane Aly Diallo, is  part of the Wikiprogress focus on its Africa Network*.

 “African societies, like any other societies indeed, have to measure progress. But more importantly they have to define what is meant by progress. They have to hold a dialogue in a way that has not been done before.” – Pali Lehohla (Director General of Statistics South Africa).

Welcome to this week’s review of progress initiatives, articles and reports that focus on Africa. Here are the highlights from this week:

  • The Global Humanitarian Assistance Report has been released. This year’s report focuses on how international assistance has responded to humanitarian crisis, with sections on funding, recent emergencies and quick response to humanitarian crisis. The report sheds light on the growing role of non-traditional donors, the increasing levels of unmet humanitarian needs, as well as the importance of transparency and access to reliable information. 
  • Abuja+12: Shaping the future of health in Africa. African Heads of Governments and States pledged during the AU Abuja Summit to eliminate pandemics, such as HIV/AIDS, Malaria and Tuberculosis, in Africa by 2030, as well as improve their national health systems and strengthen their pharmaceutical capacities. This summit helped to renew the commitments made during the Millennium Summit and the Abuja Summit in 2001.

  • The Millennium Development Goals Report 2013 by UNDP, looks at the areas where action is needed most (i.a. hunger; maternal health; sanitation and environmental protection). This report also shows that the achievement of the MDGs has been uneven among and within countries.

  • The Open Data for Africa initiative, hosted by AfDB, is now available for all 54 African countries. It is part of AfDB’s “Africa Information Highway” initiative, aiming to improve data collection, management, and dissemination in Africa. It will allow open access to the necessary data in order to manage and monitor development results in African countries, including tracking progress on the MDGs. (See video below.)

  • The Economist devoted a special report on the Arab Spring, two years after its inception. The author Max Roedenbeck argues that the aspirations behind the movement are yet to be met and he proceeds to review what has been achieved so far. Duncan Green of Oxfam reviews the report and highlights its main points in this post.

  • Malala Yousafzai spoke at the United Nations General Assembly this 12 July in defense of education for all, particularly for young girls. This blog, outlines three necessary steps to increase youth participation: listening, increasing involvement in decision-making as well as involvement in the implementation process.

We hope you enjoyed the week-in-review. Stay tuned the same time next week for another riveting read on the week that was.

 Yours in progress,

* Wikiprogress Africa Network aims, to provide a platform for knowledge sharing on measuring progress in an Africa context.

Childhood Pneumonia and Diarrhoea KILLS!

This article, by Ousmane Aly Diallo, Wikiprogress Africa Advisor, is part of the Wikiprogress Health Series. Wikiprogress Africa aims to  provide a platform for knowledge sharing on measuring progress and well-being in an Africa context. 

We know what works against pneumonia and diarrhoea – the two illnesses that hit the poorest hardest. Scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival, help give every child a fair chance to grow and thrive, Anthony Lake, UNICEF Executive Director.

The Lancet recently published a series of papers on Childhood Pneumonia and Diarrhoea in collaboration with the Aga Khan University of Pakistan, in April 2013.  The series demonstrates that it is possible to eradicate the prevalence of these two diseases among children through a comprehensive strategy involving all the stakeholders and highlights the barriers that have enabled children’s death from it.

Pneumonia and diarrhoea are low in incidence in the developed world but remain serious health concerns in the developing world. Childhood Pneumonia and Diarrhoea are particularly lethal in the developing world; nearly 90% of the children who died from these diseases are from Sub-Saharan Africa and South Asia, according to a recent World Health Organization report.

Assessing  the global burden of childhood pneumonia and diarrhoea in the world,  Walker and Alii’s paper show that these two diseases remain the leading infectious causes of death in children younger than 5 years, and caused an estimated 700 000 and 1·3 million deaths, respectively, in 2011. 

According to the study, more than half of the burden (56% of severe episodes of diarrhoea and 64% of severe episodes of pneumonia) is upon 15 countries and among this category, 10 of them are Sub-Saharan Africa’s ones: Angola, Burkina Faso, Democratic Republic of the Congo, Ethiopia, Kenya, Mali, Niger, Nigeria, Tanzania, and Uganda. Most of these deaths could have been prevented through vaccines and other means of prevention according to this study. Besides, undernourishment constitutes another obstacle to these children’s survival. Any program to tackle childhood pneumonia and diarrhoea should include a facet on improving child nutrition.

Lack of national leadership in the fight against these diseases and a lack of financial resources are important bottlenecks. This, coupled with the inadequate training of health workers, and a lack of health indicators, are key obstacles that need to be addressed to lower the morbidity rate of pneumonia and diarrhoea among children and to improve their survival rates, for these authors.

The second paper on “Interventions to address deaths from childhood pneumonia and diarrhoea…” shows that scaled interventions could save 95% of diarrhoea and 67% of pneumonia deaths in younger children (under 5 years) by 2025. But to reach that goal, the emphasis must be put on community-level healthcare as it is the best way to reach the most exposed populations. 

This series show that childhood pneumonia and diarrhoea are serious health concerns in many developing countries, particularly in Sub-Saharan Africa, but that they could be eradicated through prevention (immunisation campaigns) and effective intervention. In its subject and objectives, this series echoes the recent publication by the World Health Organization and UNICEF, the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. This plan aims to reduce by 75% (with 2010 levels as reference) the incidence of severe pneumonia and diarrhoea, as well as the death from both these diseases among children under-five. It also aims for a 40% reduction in the global number of children under five who are stunted since undernutrition is one of the key risk factor for children suffering from pneumonia and diarrhoea. There’s a global commitment to ending child death from preventable diseases and these two Lancet publications show that this objective is reachable if all means are galvanised.

Childhood diarrhoea and pneumonia are deadlier in low-income countries of Sub-Saharan Africa and South Asia than in the developed world. Closing the gap is one of the ultimate aims of the Lancet series as shown through different models, it is an objective that is within our reach.

To find out more about Wikiprogress Africa, click here

Ousmane Aly DIALLO
(Wikiprogress Africa Advisor)