By Jomo Kwame Sundaram and Nazihah Noor
KUALA LUMPUR and BERN, Jul 19 2023 – In 2015, almost all heads of government in the world committed to the United Nations’ Sustainable Development Goals (SDGs), including universal health coverage (UHC). This was consistent with the World Health Organization’s commitment to Health for All.

The COVID-19 pandemic exposed most countries’ under-investment in public healthcare provisioning and other weaknesses. Clearly, health system reforms and appropriate financing are needed to improve populations’ wellbeing.

Jomo Kwame Sundaram

Instead of helping, more profit-seeking investments and market ‘solutions’ in recent decades have undermined UHC. Health markets the world over rarely provide healthcare for all well. Instead, they have increased costs and charges, limiting access. Worse, public funds are being diverted to support profits, rather than patients.

Health inequalities growing
Recent decades have seen healthcare in many developing countries trending towards a perceived two-tier system – a higher quality private sector, and lower quality public services. Many doctors, especially specialists, have been leaving public service for much more lucrative private practice.

This ‘brain drain’ has worsened already deteriorating public service quality, increasing waiting times. Hence, more of those with means have been turning to private facilities. As private medical charges are high in developing countries, many who can afford private health insurance, buy it.

If unchecked, the gap – in charges and quality – between private and public health services will grow, increasing disparities between haves and have-nots. Social solidarity implies cross-subsidization in health financing – with the healthy financing the ill, and the rich subsidizing the poor. Social solidarity also enables universal coverage and equitable access.

Better healthcare for all
Most governments need to strengthen public provisioning of comprehensive health protection with adequate financing. Meanwhile, healthcare costs have gone up due to more ill health, the rising costs of new medical technologies, privatization and less public procurement.

Everyone – nations as well as families – faces more unexpected health threats, worsened by rising catastrophic and other medical expenses, more economic vulnerability, greater income insecurity, declining public provisioning, and costlier coping strategies.

Nazihah Noor

‘Premature’ death, disability and illness have meant losing billions of years of healthy life, largely due to preventable non-communicable diseases (NCDs). Although they cause many health losses, relatively little public health spending goes to NCD prevention.

Spending and outcomes
Most countries, including in the developing world, have seen rising healthcare spending. But there is no direct relationship between health expenditure and wellbeing. Hence, more spending does not ensure better outcomes, whereas appropriate public healthcare provisioning does.

Although health spending has been rising in many developing countries, it has generally remained low in relation to income. Government health services were already facing fiscal constraints before the pandemic. To cope with COVID-19, public health expenditure in many middle-income countries spiked.

Chronic underinvestment in public services has undermined healthcare overall. Many underfunded systems have nonetheless improved health conditions, reducing morbidity and mortality. Decent health outcomes, despite relatively low health spending, imply greater public expenditure ‘cost-effectiveness’ or efficiency.

Nonetheless, much more could be achieved with better policies, increased spending and more appropriate priorities. Thus, reducing child and maternal mortality, besides improving sanitation and water supplies, have significantly raised life expectancy in developing countries.

Improving policy
To enhance wellbeing, health systems must better protect people from current and future threats and challenges. Better public healthcare financing – with absolutely and relatively more, but also more appropriate funding – seems most important.

Developing country governments are often fed oft-repeated, but doubtful claims that current government healthcare spending is too high, and health insurance is necessary to fill the funding gap. Instead, official revenue should mainly fund health budgets to ensure efficiency and equity.

Health promotion should involve more preventive efforts. By mainly focusing on curative interventions, most government spending and policy priorities neglect determinants of wellbeing, including inequities. Some WHO recommended policies deemed most cost-effective target tobacco products, harmful alcohol use and unhealthy diets.

Policy coherence
To better address overall wellbeing, a more comprehensive and integrated approach should integrate health with related public policies. Affordable healthier food options, physical exercise and healthier lifestyles deserve far greater emphases.

For example, a cheap, but nutritious, safe and healthy daily school feeding programme in Japan – introduced a century ago, when it was still quite poor – has ensured life expectancy in the archipelagic nation has been the world’s highest for decades.

An ‘all-of-government’ approach should ensure meals planned by dieticians, mindful not only of good nutrition, but also of local food cultures, costs, safety and micronutrient deficiencies. With a ‘whole-of-society’ approach, involved parents can ensure schoolchildren are fed safe food from farmers not using toxic pesticides.

This can be ensured with the food or agriculture ministry’s participation. Farmer organizations can be contracted to supply needed foodstuff with initial support from government agricultural extension services, not corporate salesmen. This, in turn, improves the safety of all farm produce, ensuring healthy food for all.

Health reform recommendations should prioritize governments’ major commitments – to the people and the international community – of ‘universal health coverage’ to ensure ‘health for all’.

Nazihah Noor is a public health policy researcher. She led two reports on health system issues in Malaysia, Social Inequalities and Health in Malaysia and Health and Social Protection: Continuing Universal Health Coverage. She is currently pursuing a PhD in public health in Switzerland.

IPS UN Bureau

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By Philippe Benoit and David Sandalow
WASHINGTON DC, Jul 19 2023 – Africa is caught in the crosshairs of climate change. Despite contributing just 3-5% of global carbon dioxide emissions, the continent will endure climate change’s destructive impact, including more severe storms, rising temperatures and erratic rainfall in the years ahead that threaten the well-being of hundreds of millions of people.

Renewable energy is an important part of the solution – and Africa enjoys an enormous potential in this regard. With some of the world’s highest levels of solar irradiance, vast expanses of land with favorable wind conditions and powerful rivers with immense hydroelectric potential, Africa is teeming with renewable energy resources. However the continent’s progress in tapping into this potential lags, leaving a huge energy access challenge as well as a power generation deficit that is stunting business and other drivers of inclusive economic growth.

As the world gears up for the 28th Conference of the Parties to the UN Framework Convention on Climate Change (COP28) to be held in the United Arab Emirates (UAE), the need to address Africa’s energy needs sustainably is all too apparent. Doing so will require rethinking the approach and reshaping policies to dramatically grow Africa’s energy system.

As COP28 President Sultan Al-Jaber said at last month’s climate finance summit held in Paris, “For countries that have done the least to cause climate change, climate finance remains unaccessible, unavailable and unaffordable….” Can COP 28, with UAE leadership, deliver for Africa on this potential?

This will require big and bold actions, including massive investments in large-scale infrastructure. It will also require investment in information and other soft assets.  And, significantly, it will also necessitate  small and micro-scale grassroots initiatives which are particularly important to ensure that local populations remain active participants in the process.

The shortage of energy in Africa is a pressing problem. Over half the people in Africa still don’t have electricity access — a major contributor to persistent poverty.  This gap drives households to rely on inefficient and polluting energy sources like charcoal, wood, and kerosene. This pervasive energy deficit, highlighted in the ‘Tracking SDG7: The energy progress report for 2022’ has profound implications for health, education, and sustainable development across the continent.

An even larger portion of the population lacks access to clean cooking technologies, a crisis disproportionately affecting women and girls, and exposing them to harmful household air pollution that was responsible in 2019 for approximately 700,000 deaths across Africa. Rather than diminishing, the number of people without access is projected to potentially rise from 923 milion in 2020 to 1.1 billion in 2030.

But Africa’s energy problem extends beyond the lack of access to electricity and clean cooking targeted by SDG#7.  In too many places across the continent, there is a lack of sufficient and reliable electricity to power businesses that are the backbone of Africa’s growth drive.  The result is a combination of inadequate supply or expensive generators acquired to compensate for the inefficiencies.  Fundamentally, Africa’s ability to stimulate local entrepreneurs or attract international developers and capital is too often being undermined by a weak electricity network.

The shift in focus to renewables provides an opportunity to change the narrative and realities of Africa’s power system.  The large amounts of financing being discussed for climate (including in the lead-up to and at COP 28) – amounts which tend to exceed the levels of funding traditionally mobilized for poverty alleviation – provide an important opportunity for the continent.

Mobilizing funding to harness Africa’s bountiful renewable energy would not only help to meet its current and increasingly large future energy needs, but also contribute to global efforts to avoid prospective greenhouse gas emissions.

Moreover, Africa’s renewables are large enough to both meet domestic needs, and also help to power green development abroad, including through the export of green electricity to Europe or even, eventually, hydrogen generated from its massive hydropower resources.

Unlocking Africa’s renewable potential will require supportive policies, robust regulations, technological innovation, and substantial investment. Strong, sound and predictable regulatory frameworks and institutions are key.

Better information is also key. For example, the African Energy Commission has established the Strategic Framework on the African Bioenergy Data Management  that seeks to raise awareness of the potential of the bioenergy sector, reflecting the specificities of the reality on the ground in the region.

Given Africa’s limited financial resource base, any solution requires reaching beyond Africa’s borders.  Wealthy nations can bring capital, expertise, and adapted technologies to the continent. South-South cooperation can encourage peer learning, the dissemination of technological solutions adapted to local climatic conditions and the developing country economic context, and support the deployment of the increasing financial capacities of emerging economies to support Africa’s renewables.

Multilateral development banks, development finance institutions, export credit agencies and private capital should also all do more.

The hosting of COP28 in the UAE provides an opportunity to mobilize funding for Africa from a broader set of actors and countries, moving beyond the traditional North/South divide.  In fact, climate finance has been identified by the COP28 host as one of the key goals of this COP. As COP28 President Sultan Al-Jaber said at last month’s climate finance summit held in Paris, “For countries that have done the least to cause climate change, climate finance remains unaccessible, unavailable and unaffordable….” Can COP 28, with UAE leadership, deliver for Africa on this potential?

One UAE initiative – the Zayed Sustainability Prize – has already helped promote local action in addressing these challenges.  (One of the authors is a member of the Selection Committee for the Prize.) Over the years, the Zayed Sustainability Prize has supported sustainable change around the world by recognising and rewarding innovative and impactful organizations working to overcome development barriers, including limited access to reliable power, clean water, quality healthcare, and healthy food.

For example, M-KOPA, which won in the Energy category in 2015, uses digital technology to help its customers make micropayments towards essential products and services, such as smartphones, refrigerators, solar panels, even bank loans and health insurance. Last month, it closed US $250 million in new funding to expand its fintech services to underbanked consumers in Kenya, Nigeria, and more recently, Ghana.

Another winner was the Starehe Girls Centre which empowers disadvantaged girls by providing them access to quality education. The school won the Prize in 2017 in the Global High Schools category in recognition of its efforts to reduce its utility bills through the installation of solar panels and more efficient lighting. These financial savings have allowed it to admit more girls from disadvantaged backgrounds.

Generating local action is a critical input to ensure that massive investment programs translate into a just transition for households. To this end, large-scale infrastructure must be accompanied by people-centric programs.

Africa’s renewable energy potential could both help drive enormous economic growth in the region while also helping the world address the challenge of climate change. The potential is there, and it will require action …  in ways big and small.

(Article first published in Nation (Kenya edition) on July 3, 2023)

Philippe Benoit is research director for Global Infrastructure Analytics and Sustainability 2050. He previously held management positions at the World Bank and the International Energy Agency and has over 20 years of experience working on Africa.

David Sandalow is Inaugural Fellow at the Center on Global Energy Policy, Columbia University, and a member of the Selection Committee of the Zayed Sustainability Prize.

The video shows an empty house with even the door frames and windows torn out. Graffiti on the wall recalls that the building was once requisitioned by the Sham Legion, an Islamist faction from northern Syria. “I was very curious so I asked a relative to send me the video to see what state our […]

By Oluwafemi Olaniyan and Abigail Van Neely
ABUJA & UNITED NATIONS, Jul 18 2023 – As Russia paused the renewal of the Black Sea Grain Initiative, the United Nations Secretary-General António Guterres reacted with regret saying the global south would be badly affected.

A Kremlin spokesman, Dmitri Peskov, on Monday, July 18, said the agreement was “suspended.”

“As soon as the Russian part is fulfilled, the Russian side will immediately return to the implementation of that deal,” Peskov said. 

The Russian Federation’s decision to terminate the Black Sea Grain Initiative will “strike a blow to people in need everywhere,” Guterres said in reaction.

Stephane Dujarric, spokesman for the secretary-general, acknowledged that Ukraine and Russia produce an enormous number of products needed on the global food market. The impact of the deal’s termination was immediate, with wheat prices increasing 3 percent when the news broke.

Guterres emphasized that the Black Sea Grain Initiative and Memorandum of Understanding on facilitating exports of Russian food products and fertilizers “have been a lifeline for global food security and a beacon of hope in a troubled world.”

“Ultimately, participation in these agreements is a choice,” Guterres said. “But struggling people everywhere and developing countries don’t have a choice. Hundreds of millions of people face hunger, and consumers are confronting a global cost-of-living crisis. They will pay the price.”

Dujarric said Guterres was disappointed his proposals in a letter to President Putin went “unheeded.”

“The letter that [Gutteres] sent to President Putin was a very clear illustration of his determination to keep this alive for the benefit of people in the global south for the benefit of vulnerable people everywhere, for whom an increase in food prices has a direct impact – and it includes people in rich countries and in poor countries,” Dujarric said.

According to Dujarric, Guterres did not receive a formal response to his letter.

The Joint Coordination Centre that facilitates the implementation of the initiative remains available for discussions in Istanbul. A final vessel is being inspected.

In a diplomatic flurry, South African President Cyril Ramaphosa last week discussed the initiative with Russian President Vladimir Putin. But according to reports, Russia said it could not continue with the initiative because promises, which include the export of fertilizer and, according to Reuters, connecting a subsidiary of Russia’s agricultural bank to the international payment system SWIFT, which enables payments to be made, had not been fulfilled.

Ukraine is one of the world’s largest exporters of grain. Before the Russian invasion in February 2022, Ukrain supplied around 45 million tonnes of grain to the world market annually. According to the Food and Agriculture Organization (FAO), 16 African countries rely strongly on the agricultural produce of Russia and Ukraine. The invasion triggered a shortage of at least 30 million tonnes of food globally, impacting countries like the Horn of Africa, where climate change, conflict, and bad governance have sparked a food security crisis affecting about 50 million people.

Wealthier Countries Main Beneficiary of Exports

However, data on the initiative indicates that China and Spain were the two biggest beneficiaries of the grain, although the World Food Programme (WFP) said the initiative was crucial to its support of humanitarian operations in Afghanistan, Ethiopia, Kenya, Somalia, Sudan, and Yemen.

A data set of countries that benefitted from the Black Sea Grain Initiative. Credit: UN

Of the 32.9 million tons exported, 43 percent went to developed countries and 57 to developing countries. Exports by World Bank categories show that 44 percent went to high-income countries. Upper-middle-income countries received 37 percent, lower-middle-income countries 17 percent, and low-income countries just 3 percent.

World Food Programme (WFP) Director David Beasley said: “Africa is very fragile right now. Fifty million people (are) knocking on famine’s door.” He warned that if Moscow should shut down or blockade the ports, there would be a catastrophe, notably in Africa, where millions of people are facing famine.

“Food prices, fuel costs, debt inflation, and three years of COVID, the people have no more coping capacity, and if we don’t get in and get costs down, then 2024 could be the worst year we have seen in several hundred years”.

Solutions to Africa’s Foreign Dependence on Food Products

Steve Wiggins, a food expert at ODI, a global think-tank based in the UK, noted that Africa’s dependence on imports was often misunderstood.

“African nations’ dependence on foreign aid is very high; African nations are always depending on importation even as far back as before their independence and even after independence. But many African countries do not rely on imports for their staples, contrary to what many people assert. What Africa tends to import is higher-value food: frozen chicken, canned tuna, packed biscuits, packet noodles, and so on. If you look at imports of the main staples, for most countries, 15% or less, often far less, is imported.”

He said rising imports did not indicate agricultural failure.

“This is a common misunderstanding: the idea that Africa is so far from feeding itself that rising food imports means agricultural failure. No, often rising food imports reflect economic growth and the ability of urban middle classes to afford imported food.”

Chris Gilbert, a commodity market analyst, says, “The invasion of Ukraine pushed wheat prices up by just 5% – a very small share of the increase in wheat prices seen from April 2020 to May 2022. He points out that the Black Sea initiative has been a key reason why the invasion did not push wheat, maize, and sunflower prices higher and why prices fell back after May 2022”.

Steve Wiggins, a food expert based in the UK, noted that “Africa’s vulnerability to price rises varies hugely by place and circumstance. Some countries, such as Egypt and Sudan, are heavily exposed to rising costs of wheat imports. In other parts of Africa, hard-pressed working mothers have taken to sliced bread, noodles, and pasta as near-instant food they can prepare quickly for their children when they return from work.”

Alex Abutu, the Communication Officer for West and Central Africa at the African Agricultural Technology Foundation, said it was time for Africa to put resources into agriculture to lessen the dependence on imports of basic foodstuffs.

He said African governments are yet to fully follow the Maputo Declaration on Agriculture and Food Security resolutions, which include allocating 10 percent of national budgets to agricultural development – a trend experts say undermines the growth of African agricultural development.

“Africans should go beyond manual labor if they really and truly want to satisfy themselves. Precision agriculture should be encouraged and inculcated … Seed buying should be encouraged; grains are meant to be eaten and not replanted; a good seed will surely germinate because it has undergone purification and has been checked well, unlike a grain that might have got infected, and this will affect the yields from it, a seed will surely bring about 99 percent yield but a grain will not. It reduces yields.”

Additional reporting: Cecilia Russell
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By Armida Salsiah Alisjahbana
BANGKOK, Thailand, Jul 18 2023 – The world faces a disaster emergency, yet nowhere is the threat more immediate than in Asia and the Pacific. Ours is a region where climate change-induced disasters are becoming more frequent and intense. Since 1970, two million people have lost their lives to disasters.

Tragically, but all too predictably, the poorest in the least developed countries (LDCs) are worst affected. They will find themselves in the eye of the storm as temperatures rise, new disaster hotspots appear and existing risks increase.

Unless we fundamentally change our approach to building resilience to disaster risk, temperature rises of 1.5°C or 2°C will make adaptation to the threat of disasters unfeasible. Disaster risk could soon outpace resilience in Asia and the Pacific.

It is worth pondering what this would mean. The grim tally of disaster-related deaths would inevitably rise, as would the annual cost of disaster-related losses, forecast to increase to almost $1 trillion, or 3 per cent of regional GDP, under 2°C warming ¬ up from $924 billion today, or 2.9 per cent of regional GDP.

The deadly combination of disasters and extreme weather would undermine productivity and imperil sustainable development. In the poorest parts of our region, such as the Pacific small island developing States, disasters would become a major driver of inequality.

Losses would be particularly devasting in the agriculture and energy sectors, disrupting food systems and undermining food security as well as jeopardizing energy supply and production. Environmental degradation and biodiversity loss would be remorseless, leading to climate change-driven extinctions and further increasing disaster risk.

To avoid this exponential growth of disaster risk, there is a narrow window of opportunity to increase resilience and protect hard-won development gains. To seize it, bold decisions are needed to deliver transformative adaption. They can no longer be postponed.

Next week, countries meeting during our Committee on Disaster Risk Reduction will consider key questions such as prioritizing greater investment in early warning systems. Expanding coverage in least developed countries is the most effective way to reduce the number of people killed.

Early warning systems can shield people living in multi-hazard hotspots and reduce disaster losses everywhere by up to 60 per cent. They provide a tenfold return on investment. To protect food systems and reduce the exposure of the energy infrastructure – the backbone of our economies – sector-specific coverage is needed.

Investments at the local level to improve communities’ response to early warning alerts, delivered through expanded global satellite data use and embedded in comprehensive risk management policies, must all be part of our approach.

Nature-based solutions should be at the heart of adaptation strategies. They support the sustainable management, protection and restoration of degraded environments while reducing disaster risk. The evidence is unequivocal: preserving functional ecosystems in good ecological condition strengthens disaster risk reduction.

This means preserving wetlands, flood plains and forests to guard against natural hazards, and mangroves and coral reefs to reduce coastal flooding. Forest restoration and sustainable agriculture are essential. In our urban centers, nature-based solutions can mitigate urban flooding and contribute to future urban resilience, including by reducing heat island effects.

Beyond these priorities, only transformative adaption can deliver the systemic change needed to leave no one behind in multi-hazard risk hotspots. Such change will cut across policy areas. It means aligning social protection and climate change interventions to enable poor and climate-vulnerable households to adapt and protect their assets and livelihoods.

Disaster risk reduction and climate change adaptation must become complementary to make food and energy systems more resilient, particularly in disaster-prone arid areas and coastlines. Technologies, such as the Internet of Things and artificial intelligence, can improve the accuracy of real-time weather predictions and how disaster warnings are communicated.

Yet to make this happen, disaster risk financing needs to be dramatically increased and financing mechanisms scaled up. In a constrained fiscal context, we must remember that investments made upstream are far more cost-effective than spending after a disaster.

The current level of adaptation finance falls well short of the $144.74 billion needed for transformative adaptation. We must tap innovative financing mechanisms to close the gap. Thematic bonds, debt for adaptation and ecosystem adaptation finance can help attract private investment, reduce risk and create new markets.

These instruments should complement official development assistance (ODA) , while digital technologies improve the efficiency, transparency and accessibility of adaptation financing.

Now is the time to work together, to build on innovation and scientific breakthroughs to accelerate transformative adaptation across the region. A regional strategy that supports early warnings for all is needed to strengthen cooperation through the well-established United Nations mechanisms and in partnership with subregional intergovernmental organizations.

At ESCAP, we stand ready to support this process every step of the way because sharing best practices and pooling resources can improve our region’s collective resilience and response to climate-related hazards. The 2030 Agenda for Sustainable Development can only be achieved if we ensure disaster resilience is never outpaced by disaster risk. Let us seize the moment and protect our future in Asia and the Pacific.

Armida Salsiah Alisjahbana is Under-Secretary-General of the UN and Executive Secretary of the Economic and Social Commission for Asia and the Pacific (ESCAP)

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