Swedes, chimps, and you and me on sustainable development

Hans Rosling shows how the child mortality rate declined at a phenomenal rate across the globe between 1964 and 2012.

Lea en español *** Lisez en français


>>Authored by Sabina Rogers

Earlier this year at the World Economic Forum (WEF), Hans Rosling opened his presentation, “Sustainable Development: Demystifying the Facts,” with three questions for the audience about the state of global development (about extreme poverty, measles vaccination, and population in 2100). He was testing their knowledge in order to illustrate how preconceived ideas will do us wrong.

He had done this test before. Rosling conducted studies with Swedes, Americans, and chimps about the state of global development. The chimps were asked to choose a banana that is associated with 1 of 3 possible answers, and they got the answer correct 33 percent of the time. In essence, they were bound to be right 1 time in 3; the humans were not as lucky. Basically, according to his study, chimps in a zoo have a better chance of choosing the right answers at random to questions about the state of the world than the average Swede and American does.

It is detrimental when we underestimate the progress that has been made just in the last 15 years. In 1964 (the date he starts with his child mortality chart), the world was clearly divided into two worlds: the developing world with large families and high child mortality and the developed world with the opposite. Today, there really is just one world, with a few outlying countries, mainly in Africa.

It’s also a world of inequality within countries. Take India, for example. “If someone comes from outer space and wants to see the world,” says Rosling, “and [they] have only one day to visit, they should go to India. Because they can see everything in India: the most fantastic success [and] progress being made, but also remote, rural areas where still, extreme poverty is rampant — but decreasing.”

This is where the post-2015 agenda has to focus the world’s energy and money: the still marginalized, the remote and hard-to-reach areas. This is why we at the Microcredit Summit Campaign are championing six financial inclusion strategies (our “six pathways“) that we believe hold the greatest promise in helping to end extreme poverty at the frontiers — at the margins of society in economic, social, and geographic terms. The six pathways offer a means to reduce the cost of delivery (mobile money), help the poor build assets (cash transfers linked with savings), tackle the challenge of a weak health infrastructure, and more.

But, this isn’t just about practitioners and donors. With the launch of the Global Goals for Sustainable Development, we are seeing a massive media campaign targeted at you and me. It is a media campaign designed to get people excited and believe in the possibility of achieving the SDGs. Each goal has been reworded to express greatly simplified concepts. No numbers. No percentage signs. Just simple framing: No poverty, no hunger, good health, and so on.

It is also is designed to put “we the people” in the driver’s seat of this “next generation” of development. This is good because we are going to need everyone behind this agenda to fund it and traditional “aid” funding will not suffice. Tax revenue must contribute to the estimated $172.5 trillion price tag (over 15 years). The MDGs cost $915 billion in total. That’s $114 billion per goal compared to more than $10 trillion per goal for our post-2015 agenda.

In an interview on NPR’s Goats and Soda blog, Paul O’Brien of Oxfam America said, “It’s not just about more aid and donors doing more. This is going to be about sustained political will by governments to use their own money to tax corporations more effectively and make sure the money from their natural resources goes to poverty reduction.” This is the same conclusion in Who Pays for Progress?, a report from RESULTS UK about how to finance healthcare in new middle income countries. And, we can only do this if we understand what Rosling is trying to show us with his charts: “We can make the world much better. The long-term trend is going in the right direction.”

I would add, don’t underestimate what a world united by a set of global goals can achieve.

Watch Hans Rosling’s presentation at the World Economic Forum

Here is Rosling’s first question for WEF attendees:

In the last 20 years, the proportion of people living in extreme poverty has…? A. almost doubled, B. remained more or less the same, C. almost halved.

The answer was C (though the numbers of extreme poor may not have decreased in absolute terms). How many got it right? 61 percent of respondents from the WEF were right; in an online survey he conducted, 23 percent from Sweden and 5 percent from the US answered C.

How many of the world’s one-year-old children are vaccinated against measles? A. 2 in 10, B. 5 in 10, C. 8 in 10.

Again, the answer was C, and 23 percent of WEF got it, 8 percent of Swedes, and 17 percent of Americans.

How many children will there be in the world in 2100? A. almost 4 billion, B. 3 billion, C. 2 billion (with no increase from 2000).

26 percent of the WEF audience answered the correct answer, C, 11 percent of Swedes, and 7 percent of Americans. Rosling’s chimps surveyed answered correctly 33 percent of the time.

What does this mean? When you answer worse than random, it means that the problem is not lack of knowledge, the problem is that you carry preconceived ideas, which makes your score worse than chimps.

The whole point of this exercise queued up his presentation (starting at 6:33) on the state of child mortality between 1964 and 2012 (hint: the vast majority of countries are doing amazingly well). He showed how child mortality today in Bangladesh (8:52) is better than the state of child mortality in Italy in 1964 and that even the worst off families (women with absolutely no education) are, today, where the better-off and most-educated Bangladeshis were in 2001.

Hans Rosling shows why the concept of “developing countries” (those with less than US$12,000 per capita) doesn’t have much meaning anymore — for a happy reason. We have great reason to be optimistic about ending extreme poverty by 2030.

The main reason for optimism is the evidence of the past…the long term trend is going in the right direction.

Post MDG-4: Integrating health services to reduce child mortality

Millennium Development Goals: 2015 Progress Chart
Published articles to date: Introduction | MDG 1 | MDG 2 | MDG 3

Lea en español *** Lisez en français


The United Nations recently issued The Millennium Development Goals Report, 2015, the latest assessment of progress towards the eight MDGs. In short, they have had mixed results. This article is part of a blog series reflecting on the MDGs and the U.N. report. These are produced in partnership with our colleagues at RESULTS.


>>Authored by Carley Tucker and Sabina Rogers

MDG 4: Reduce child mortality

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

From The Millennium Development Goals Report, 2015

From The Millennium Development Goals Report, 2015

The numbers appear heartening. According to the latest assessment on the Millennium Development Goals (MDGs), deaths of infants and children under five have greatly reduced. The under-five mortality rate has declined by more than half, from 90 to 43 deaths per 1000 births. Moreover, the annual rate of reduction in child deaths has more than doubled since 1990, and the rate has accelerated the most in Africa.

We learn that 4 out of every 5 of children have received at least one dose of the measles vaccine, preventing 15.6 million deaths between 2000 and 2013. In all, some 48 million children under five are alive today because of smart investments and increasing access to cost-effective health programs over the last 15 years.

This is good news for children around the world; however, underlying these advances is news that the achievements are not equitably distributed regionally, between rural and urban areas, nor socioeconomically.

Across all regions, progress toward MDG 4 has been “fair” to “excellent.” Furthest from reaching the target, though, are those living in sub-Saharan Africa and South Asia. While sub-Saharan Africa has had the largest decline in child mortality rates, it still experiences half of all child deaths in the world. Of the 10 countries with the highest number of under-five deaths, 5 are in Africa: Nigeria (#2 at 750,000), DR Congo (#4 at 305,000), Ethiopia (#5 at 184,000), Angola (#7 at 169,000), and Tanzania (#10 at 98,000). See the full list in this infographic from Humanosphere.

Children living in rural areas are 1.7 times more likely to die than those living in urban populations. Child mortality is 1.9 times as prevalent among poor households as among wealthy. Those whose mothers lack education are 2.8 times more likely to die than if their mothers had reached the secondary or higher level. So, of the 16,000 children under five who die each day — mostly due to preventable causes such as pneumonia, diarrhea, and malaria — they are likely to be from poor, rural, and uneducated households.

Have we really made substantial progress achieving MDG 4 when young kids in rural and poor communities continue to be the ones more likely to die before their fifth birthday? Allowing this population to fall behind will only exacerbate the vicious cycle of poverty. In order to make permanent advances in reducing early deaths, global development actors need to narrow in on rural and impoverished areas, especially in sub-Saharan Africa and South Asia.

Where do we go from here?

Recognizing the need for a renewed effort towards improving health of the poorest households, the Microcredit Summit Campaign has identified integration of health and microfinance programming as one of its six pathways strategies key to ending extreme poverty. Poverty is both a factor contributing to and consequence of illness and disease, so it is not enough for clients to have access to financial services. The microfinance sector must look for ways to integrate healthcare to their microfinance services. Microfinance institutions (MFIs) can provide health services directly or through linkages with healthcare programs.

Campaign believes that microfinance services provide an optimal place for healthcare. Many MFIs are reaching very rural communities — to say nothing of savings groups, which are primarily a rural financial tool. MFIs have developed trust relationships with families; they meet regularly with clients and can, therefore, pass along information like how to care for their children. In addition, since many MFIs serve regions in Africa and South Asia where child mortality rates are the highest, a strong focus on healthcare will allow these organizations to directly combat this issue in the most afflicted regions.

Microfinance clients must also have access to good healthcare in order to run their businesses, and a healthy lifestyle begins at birth. In the “Healthy Mothers, Healthy Babies: Kalinga kay Inay” project, microfinance clients are learning simple but important lessons like the food and nutritional supplements that pregnant and young women need and the importance of giving birth in a health facility. They are attending community health fairs organized by CARD MRI and partners, receiving free gynecological exams, urinalysis, and vitamins and supplements to improve their chances of delivering a healthy baby.

70 percent of maternal and child deaths now concentrated in just 16 countries, health and non-health investments such as sanitation, education, infrastructure and gender equality can potentially double the impact on lives saved.

70 percent of maternal and child deaths are now concentrated in just 16 countries. Investments in sanitation, education, infrastructure, and gender equality can potentially double the impact on lives saved. Go to the Newborn Survival Map to learn more.

Integrating health and microfinance services will also support the efforts of the new Global Goals for Sustainable Development, which are set to be approved at the Sustainable Development Summit September 25 to 27. The ambitious Goal 3 (“Good health and well-being”) includes ending preventable deaths of newborns and children under 5 years of age by reducing child mortality to 20 or fewer deaths per 1000 births by 2030. It also seeks to reduce by one third premature mortality from non-communicable diseases through prevention, treatment, and promotion of mental health and well being.

There also efforts underway in the United States to maximize future investments by US Agency for International Development (USAID). To reach the goal of ending preventable child and maternal deaths by 2035, USAID has set bold, intermediate goals of saving 15 million child lives and 600,000 women’s lives by 2020. RESULTS, a grassroots advocacy organization, is lobbying for bipartisan legislation that will provide strong congressional oversight and ensure that “returns [are] measured in lives saved and healthy, prosperous communities.” (See the Fact Sheet.)

“We now have the chance to end these needless deaths in our lifetime,” said Joanne Carter, executive director of RESULTS and RESULTS Educational Fund (our parent organization). “The science shows we have the tools. That means in 2035 a child born in the poorest setting could have the same chance of reaching her fifth birthday as a child born in the richest.”

Free ultrasounds draw thousands to community health fairs

A doctor provides free checkups as part of a health outreach program in the Philippines. Photo by: CARD MRI

Lea en español *** Lisez en français


World leaders are convening in New York this week to finalize the Global Goals for Sustainable Development, an ambitious plan that will build on the successes and tackle problems where the Millennium Development Goals fell short. Freedom from Hunger and the Microcredit Summit Campaign are partnering with CARD Mutually Reinforcing Institutions (CARD MRI) to implement an 18-month project to address one of these MDG achievement gaps: maternal health in the Philippines. The project, “Healthy Mothers, Healthy Babies: Kalinga kay Inay,” is supported by an educational grant from Johnson & Johnson and will wrap up in December.

We have prepared a newsletter to let you know how things are going. To receive a copy of the newsletter, please sign up for our integrated health and microfinance news mailing list. Here is a sneak peek at the first issue of our Healthy Mothers, Healthy Babies: Kalinga kay Inay Project Newsletter.


Charyle is 32 years old and nine months pregnant with her fourth child. She attended the Davao City community health fair organized in July by CARD MRI, a Philippine microfinance institution (MFI), with partners from the MFIs for Health consortium.

Charyle was very excited to get an ultrasound. While Charyle goes monthly to a nearby health center for prenatal checkups, this was likely her first ultrasound. Charyle plans to deliver at a birthing center (an affordable alternative to a hospital for low-risk pregnancies). “I like it [the birthing center] better because it’s more personal,” she said. “I have PhilHealth, which helps with costs and point-of-care service.”

CARD has made a point to engage the local health insurance office of the Philippines’ national health insurance program, PhilHealth, in the fairs. Many women do not know the benefits or financial savings of PhilHealth membership, such as the fact that a year’s premium is less than a typical uninsured delivery. So, they provide orientation, enrollment of non-members, and other services to health fair attendees.

Irish (27) is four months pregnant with her first child. She has visited a health clinic three times already and plans to deliver at a regional hospital because she has hypertension. “So,” said Irish, “I think I will look at PhilHealth while at this health fair.”

Barrera (30) is 8 months pregnant with her fourth child. Barrera learned of the fair during her prenatal visit at the health center, which is within walking distance and offers free prenatal checkups. She said she decided to come to the fair “For the ultrasound — to be able to see my baby. It was my first time.” Berrera also plans to deliver at her local birthing center. “It is walking distance from where I live, and it is PhilHealth accredited, so free.”

Charyle, Irish, and Barrera were among 435 women who attended the two fairs; however, they were not typical in their prenatal care and delivery plans. OB/GYNs, general physicians, pediatricians, and other medical professionals provided services to these women that many normally would not be able to access or afford. In the four health fairs held so far, some 3600 pregnant and lactating women have gotten a free check-up.

HMHB_CMYK_English_Beveled

What else is in the newsletter?

Increasing Healthcare Access

Through “Healthy Mothers, Healthy Babies,” 8,000 women of child bearing age (primarily pregnant and lactating women) will receive education and preventive services through five community health fairs by the end of 2015. Women from the local community and surrounding areas access maternal health products and services like urine tests, OB/GYN consults, ultrasounds, sonograms, and vitamins provided by BotiCARD (part of the CARD family). Such services are otherwise unavailable them. The next health fair will be October 2-3 in rural communities in Mindanao. Contact Mharra de Mesa to learn more.

What’s in the Mother and Baby Kit?

health-kit_HMHB-PH_Oct2014_Courtesy-of-CARD-MRI

Building Capacity to Provide Health Education

What does it take to deliver maternal health education to 600,000 women? In January 2015, 17 CARD staff and 1 nurse took part in a training of trainers (ToT) on the maternal and child health education module, “Healthy Pregnancies Make Healthy Communities.” In March, four members of MFIs for Health — ASA Philippines Foundation Inc., KMBI, TSPI, and CCT — joined the Integration Workshop and ToT facilitated by CARD MRI. Learn how CARD is taking a leadership role in the Philippines to extend health products and services to more microfinance clients. Contact Cassie Chandler to learn more about the education module.

“MFIs for Health” Provide Health Services to Poor Communities

The Filipino “MFIs for Health” consortium expanded to 21 microfinance institutions (MFIs) in May when they inked a Memorandum of Agreement to provide access to health care services to poor communities. “The microfinance industry has grown so much over the past year,” Sen. Paulo Benigno “Bam” Aquino said. “It is crucial that the MFI industry should continue to innovate…and unlock more accessible opportunities that go beyond financing and bring it to our countrymen especially in the areas who have less opportunities.” Learn how the Filipino microfinance sector is mobilizing to improve the health of poor communities. Contact MAHPSecretariat@gmail.com to learn more.

To receive the full newsletter, please sign up for our
integrated health and microfinance news mailing list.


Take part in the social media buzz around the Global Goals this week!

  1. Sign up for the #GlobalGoalsLive Daily Delivery
  2. Share your stories and find out what others are doing on the #GlobalGoalsLive hub
  3. Engage with us on Twitter, Facebook, and wherever you are using the hashtag #GlobalGoalsLive

Does your microfinance program improve newborn survival?

Products provided to microfinance clients through the “Healthy Mothers, Health Babies” project in the Philippines implemented by the Microcredit Summit Campaign, Freedom from Hunger, and CARD MRI. The products included are selected for their usefulness to women soon to give birth.

Lea en español *** Lisez en français


>>Authored by Larry Reed, Director, Microcredit Summit Campaign

Research from the World Health Organization shows that half of the decline in under-5 child deaths is due to factors outside the health sector. In addition to health improvements, advancements in girls’ education, women’s economic status, water, sanitation and hygiene, energy, and infrastructure all make a vital difference. We believe that the microfinance sector has an important role to play in bringing child mortality down even further.

At the Microcredit Summit Campaign, we know how powerful integrating health programs can be. Microfinance institutions (MFIs) that offer health products and services to their clients help them to manage shocks and improve the health of clients and their families. In partnership with Freedom from Hunger and with the support of Johnson & Johnson, we are working with microfinance partners in India and the Philippines to provide health products and services to hundreds of thousands of families.

In the Philippines, our project focuses on improved health outcomes for pregnant women and their newborns. To date, CARD MRI (our local partner) has delivered the “Healthy Pregnancies Make Healthy Communities” education to nearly 300,000 women clients. The education is delivered using an innovative pictorial learning conversation (PLC) methodology developed by Freedom from Hunger. This PLC module distills important information about pre- and post-natal care into easily digested 15-minute segments.

An image from the “Healthy Pregnancies Make Healthy Communities” PLC. It teaches about the importance of visiting a health facility throughout the pregnancy.

An image from the “Healthy Pregnancies Make Healthy Communities” PLC. It teaches about the importance of visiting a health facility throughout the pregnancy. Contact Cassie Chandler at Freedom from Hunger to learn more about the education module.

At the Community Health Day events organized under the project, thousands of women (pregnant and with newborns) also get free consultations and medical checkups — many for the very first time. In addition, attendees have learned important information for ensuring healthy pregnancies and healthy newborns. Medical professionals have delivered lectures on family planning, signs and symptoms to be aware of during pregnancy, as well as prenatal care like nutrition during pregnancy and post-natal care like breastfeeding or caring for a newborn.

The Campaign is helping CARD and other members of the MFIs for Health consortium to leverage this small, one-time grant by building a strong, local resource base for their work. Through our Campaign Commitments, we are mobilizing microfinance actors around the world to take specific, measurable, and time-bound actions to address the multiple dimensions of poverty. We hope to do the same in the Philippines to improve the health of microfinance clients and their families.

Mapping integrated solutions

An effort is underway to develop a new online map to capture such programs around the world. Called the Newborn Survival Map, this initiative hopes to encourage the development of cross-sector partnerships delivering integrated solutions. In our experience, when an MFI hesitates to introduce health programs, it is often because they say that their job is to provide financial services, not health. In this case, partnering with health development organizations and other health sector actors is a viable alternative to offering health services in-house. The map could direct your organization to potential future partners in health.

The Newborn Survival Map will initially focus on 16 countries where newborn deaths are concentrated (see the map below). It will focus on programs with a total value of US$500,000 and above across 14 different sectors whose work greatly impacts newborn survival. Note that this threshold is for the life of the project and represents a total investment. Investments will also be tracked by sub-region, so it may be that an organization has a series of smaller investments in different locations or over a period of time, but the total current and planned investment for their work in a sub-region may equal or exceed the $500,000 threshold.

Priority countries (MDG 4, child mortality)

Priority countries are India, Nigeria, Pakistan, Democratic Republic of Congo, China, Ethiopia, Angola, Indonesia, Bangladesh, Kenya, Uganda, Afghanistan, Tanzania, Sudan, Sierra Leone, and Niger. Send in your program information by August 24th to be sure that you are included in the Newborn Survival Map.

The initiative is led by FHI 360, an international development organization, in partnership with the MDG Health Alliance and Johnson & Johnson. FHI 360 and partners invite actors in the microfinance sector to take part in this exciting initiative. We encourage you, our audience, to make sure that significant microfinance programs — especially those benefiting women of reproductive age — are represented on The Newborn Survival Map.

The Newborn Survival Map is in collaboration with the Every Newborn Action Plan and in support of the UN Secretary-General’s Every Woman Every Child movement.

Take action today!

Email Christina Blumel (cblumel[at]fhi360.org) with the name and email of a contact person in your organization who will be responsible for getting your microfinance program included on the map. Christina will guide your colleague through the necessary steps to an online form, which takes approximately 20 minutes to fill out.

Many thanks for your partnership as we enter the Sustainable Development Goal era where achievement of the ambitious new goals will require unprecedented levels of collaboration. Read the letter from Leith Greenslade of the MDG Health Alliance inviting your organization to be part of this exciting initiative (and en français).

About the organizations responsible for the map

The MDG Health Alliance is an initiative of the UN Special Envoy for Financing the Health Millennium Development Goals and for Malaria. The Alliance operates in support of Every Woman Every Child, an unprecedented global movement spearheaded by the Secretary-General to mobilize and intensify global action to improve the health of women and children.

FHI 360 is a nonprofit human development organization dedicated to improving lives in lasting ways by advancing integrated, locally driven solutions. Our staff includes experts in health, education, nutrition, environment, economic development, civil society, gender, youth, research and technology — creating a unique mix of capabilities to address today’s interrelated development challenges. FHI 360 serves more than 70 countries and all U.S. states and territories.

At Johnson & Johnson, our Credo inspires our strategic philanthropy to advance the health of communities in which we live and work, and the world community as well. We focus on saving and improving the lives of women and children, preventing disease among the most vulnerable, and strengthening the health care workforce. Together with our partners, we are making life-changing, long-term differences in human health.


Related reading