Brazil Crippled by Corruption

Brazil is paralyzed by corruption. The fight against it is expensive and the Country doesn’t seem able to win the battle since many political exponents are involved in corruption. Bribery is at all levels and in all areas, but is particularly damaging the health sector. The anti-corruption program is a valuable instrument but the effects on health are conflicting

By Pietro Dionisio

EU health project manager at Medea SRL, Florence, Italy

 Degree in Political Science, International Relations Cesare Alfieri School, University of Florence, Italy

Brazil Crippled by Corruption

 

For the last few years, the Brazilian society has been voicing their collective dissatisfaction with continual cases of endemic corruption, especially the ones emanating from the political bodies. After finally ascending to power in the early 2000’s, the Labor Party was expected to bring a higher level of ethics to the way government (at all levels; federal, state, municipal, etc.) conducts itself. Unfortunately, too many cases of alleged corruption followed many of the politicians who had vowed to clean up the Brazilian political process. To that effect, a significant percentage of the population felt betrayed by the Labor Party and their allies, since the expectation was for a modern, transparent, ethical government as the party waved in political campaigns. The political opposition to the labor party obviously exploits the public cases of corruption to their benefit. This was the case of the “Brazilian Democratic Movement Party” leaded by Michel Temer. But corruption still is damaging the Country.

It is just a few weeks since Luis Inacio Lula da Silva, the former Brazilian president has been condemned to nine years and six months for bribery in one of the “Lava Jato” investigations, the scandal of the Petrobras black oil giant – in which he was accused.

The investigation into corruption at the state-controlled oil company Petrobras has led to more than 100 convictions over the past three years and among the condemned are some of the country’s most influential businessmen, Temer included (the current Brazilian president). As an effect, owing to Petrobras’ role as the country’s biggest investor, Brazil’s spending policies, including for health, shrank dramatically. In December 2015, one year after the scandal outbreak, the industrial production of instruments and materials for medical and dentistry, as well as optical supplies, decreased by 14.9%, as compared to the previous year, even as the number of workers employed in the sector showed a 2.2% drop from January to December 2015.

Much like Petrobras scandal, the “Fatura Exposta”, a bribery and money laundering case, has severely impacted the country. As the Authorities allege, bribes were demanded from companies seeking to sell medical equipment (including x-ray machines, prosthetics and CT scanners) to the national healthcare system. Purportedly, between 2006 and 2017 the offenders appropriated 10 percent of the total value of all contracts (some 300 million reals, or $95 millions). As such, while the system was on the verge of collapse in 2015 and 2016, a state of financial emergency was declared, whereby even funds to pay employees were lacking.

Owing to these circumstances, it comes as no surprise that on 13 December 2016, the Senate of Brazil passed a constitutional amendment, the so called “ Death Amendment”, that caps public spending for the next two decades. If implemented, the funding cuts will impact millions of Brazilians actually relying on its Unified National Health System. In a nutshell, as investments drop, barriers to the already limited right to health in Brazil are expected to increase in a vicious circle thwarting the much needed control of health threats like Dengue fever, Zika virus, HIV/AIDS, while restricting access to preventive services.

The Petrobras scandal and the current situation in Brazil are a lesson of how corruption can affect the public health sector, mining its foundations in terms of investment, quality of services and services supply.

The Brazilian system has some elements that favor corruption and moral hazard. As for the health sector, local bureaucracy employees, who are responsible for a wide range of activities (including, just for example, contracting hospital reforms, purchasing vaccines, and paying public servants’ wages, among other things), actually have several ways to embezzle public funds, while managing millions of dollars every year.

To address the problem, in 2003, the federal government introduced the Brazilian anti-corruption program that randomly draws municipalities to be audited concerning their use of federal funds. Auditors analyze municipalities’ accounts and documentation, and physically inspect public works and service delivery, to assess whether earmarked federal transfers are effectively spent according to their guidelines. Additionally, a set of anti-corruption laws were enacted. Among these, the “Brazilian Clean Company Act” of 2014 holds companies responsible for the corrupt practices of their employees and introduces strict liability for those offences, meaning a company can be liable without a finding of fault.

All these efforts have brought positive results. In fact, the anti-corruption program substantially reduced corruption within health transfers, while decreasing occurrences of over-invoicing, off-the-record payments, and of procurement irregularities such as participation of ghost firms or tailored terms of references to specific vendors. Disappointingly, according to a study by the Harvard University, the anti-corruption program has also produced some imbalances, including by making health indicators significantly worse. Relevantly, it reduced per capita hospital beds, immunization coverage, and the share of households with access to piped water, connected to the sewage network or with septic tanks. As a result, municipality budgets have substantially lost their federal transfers (between half to all transfers loss in a cross-sectional comparison over the baseline period, amongst low-procurement-intensity transfers).

This strange outcome could be in accordance with Huntington’s claim that local bureaucracies have more accurate information about the local demand for public goods and the quality of local suppliers. On the flip-side, the anti-corruption program has produced a slowing down of money circulation. When corruption works, money flows faster since there is no competition among different players and money allocation is extremely focused. When an anti-corruption program is implemented, the criminal action is cut at its root.

As such, it is likely that in the short run, the return to a competitive market would reduce the quality and quantity of goods available, though in the long run, this issue should recover due to the competition among different players.

In my opinion, the Brazilian puzzle should be solved now that the country is expected to exit recession by the end of current year. In this regard, the optimal design of capacity-building interventions to disseminate best practices among local procurement staff, and the analysis of the extent to which those interventions can improve public service delivery, are to be pursued as relevant strategies to limit the problem in the future.

 

 

 

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Nicaragua: Teenage Pregnancy

Nicaragua currently lags behind other countries in the LAC region as for the decline of teenage pregnancies, and although the adolescent fertility rate fell sharply between 1990 and 2000, the decline has slowed considerably

By Clara Affun-Adegbulu*

Intern and Research Assistant at Institute of Tropical Medicine in Antwerp (ITM)

Teenage Pregnancy in Nicaragua

Towards Achieving the Sustainable Development Goals (SDGs)

 

Nicaragua is doing well economically. In spite of the recent slowing of the global economy, the country has managed to maintain an above average level of growth within the Latin American and Caribbean region (LAC), cut poverty rates and make progress with achieving the SGDs (The World Bank 2017). This success story is however in danger of unravelling because of the stall in the decline of teenage pregnancies. Nicaragua currently lags behind other countries in the region, and although the adolescent fertility rate fell sharply between 1990 and 2000, the decline has slowed considerably.

 

Adolescent fertility rates in the LAC region, 20151

 

Nicaraguan adolescent fertility rate, 1990-20151

 

According to La Federación Coordinadora Nicaragüense de ONG que trabajan con la Niñez y la Adolescencia (CODENI 2013)2 :

  • Births among adolescents follows social gradient. For instance, adolescent fertility is 75% higher in rural areas, and 46% of uneducated teenagers are mothers.
  • Sexual violence and a lack of access to appropriate sexual and reproductive health (SRH) information and services are the main causes of adolescent pregnancy.
  • Pregnancy poses risks to the reproductive health of the adolescent mother and exposes her child to issues such as increased risks of perinatal mortality and delayed development.
  • Adolescent mothers are more likely to stop their education early, be single mothers, have more children at shorter intervals and live in poverty.

Possible Public Policy Interventions

  1. Improve access to SRH information and services: Sex education should be offered as early as possible in schools, with a similar service provided in extra-curricular settings for children who are not in the school system. Vulnerable groups e.g. girls (and boys) in rural areas, should be targeted with tailored information.
  1. Reduce sexual violence: The prosecution of rapists should be prioritised, girls and their families should be educated about their rights, and the process of reporting crimes should be simplified and decentralised.
  1. Increase school enrolment: Primary and secondary school enrolment has been stalling in the last few years. Increasing school enrolment would have the double benefit of reducing adolescent pregnancy and preparing girls for future employment.
  1. Reintegrate adolescent mothers into the education system: teenage mothers are often excluded from the education system and later become unemployable because of their lack of skills. Providing these girls with ways of finishing their education would mean that they could break the cycle of poverty.
  1. Offer early social and medical intervention: Children of teenage mothers are at risk of poor health and social outcomes. Early intervention would mitigate this risk and reduce the inequalities and inequities that these children face.

The problem is multifaceted, however, and Nicaragua must resolve it if it is to continue its developmental trajectory unhampered and achieve SDGs such as:

  • Goal 1: No poverty
  • Goal 3: Good health and well-being
  • Goal 4: Quality education
  • Goal 5: Gender equality
  • Goal 8: Decent work and economic growth
  • Goal 10: Reduce inequalities

 

Bibliography

  1. The United Nations (UN). 2015. Transforming our world: the 2030 Agenda for Sustainable Development. United Nations Official Document: Resolution A/RES/70/1 adopted by the General Assembly on 25 September 2015. Accessed June 1, 2017.  http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E
  2. Unidad Técnica del Observatorio de Derechos Humanos de Niñas, Niños y Adolescentes de la Federación Coordinadora Nicaragüense de ONG que trabajan con la Niñez y la Adolescencia (CODENI). 2013. “Las niñas, niños y adolescentes cuentan.” Observatorio sobre derechos humanos de la niñez y la adolescencia nicaragüense. Boletín No. 5, Año 2, mayo 2013.
  3. The World Bank. 2016. LAC Equity Lab: Gender – Health. LAC Equity Lab tabulations   using WDI – World Development Indicators and Health Nutrition and Population Statistics. Accessed May 30, 2017. http://dataviz.worldbank.org/t/LCSPP/views/Gender_health/Heatlh_crosstab?:embed=y&:display_count=no
  4. The World Bank. 2017. Nicaragua: Country at a glance. Last Updated April 10, 2017. http://www.worldbank.org/en/country/nicaragua/overview

 

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* Nurse and Public Health Masters student at the Medical University and University of Vienna. She is currently interning as a research assistant at the International Health Policy unit of the Institute of Tropical Medicine, Antwerp, working on a literature review project on health systems strengthening. Clara is particularly interested in global health and development policy

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Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Zero Tolerance for FGM

Over 200 million girls and women living across 30 countries mainly in Africa as well as Middle-East and Asia share a common misery called genital mutilation / excision also known as female circumcision or Female Genital Mutilation (FGM). An additional 30 million girls are on the verge of submitting themselves into this practice in the coming decade.....The true extent of the abuse against children beginning as young as 7 and 9 years is much more than what we see in the numbers

By Jitendra Panda*

Country Director at Health Poverty Action

Universitat Oberta de Catalunya, Somalia

Zero Tolerance for Female Genital Mutilation

Legalizing Menstrual Leave for Working Women Living with FGM

 

Women and children demand and deserve more than what our governments and civil societies are currently doing to stop FGM. Over 200 million girls and women living across 30 countries mainly in Africa as well as Middle-East and Asia share a common misery called genital mutilation / excision also known as female circumcision or Female Genital Mutilation (FGM). An additional 30 million girls are on the verge of submitting themselves into this practice in the coming decade. International migration of populations to developed countries such as UK, Germany, France, Italy or USA from conflict and war torn countries such as Somalia, Ethiopia, and South Sudan has caused the migration of FGM practice which has further exacerbated the problem in other countries.  A report on unrecorded female genital mutilation (FGM) in Germany, estimated that there are 58,000 women in the country who have been victims of female circumcision. An estimation figure of FGM by the Government of UK shows that more than 180,000 women and girls are living with FGM and a further 65,000 girls under the age of 13 are at risk of FGM.

Over the last three decades national and international efforts to reduce or stop FGM have only resulted into some significant reduction in a few countries. For example, FGM prevalence rates among girls aged 15 to 19 declined by 41 percentage points in Liberia, 31 in Burkina Faso, 30 in Kenya and 27 in Egypt. Sadly however, for many other countries like Somalia, Guinea and Djibouti, FGM practices continue unabated. FGM is banned by law in several countries in Africa and Europe. These numbers do not make many senses unless there are efforts to look into the lives behind these numbers. The true extent of the abuse against children beginning as young as 7 and 9 years is much more than what we see in the numbers.

In particular, the Zero Tolerance campaign castigates the tendency to equate the benefits of FGM to male circumcision, contending that in reality FGM unlocks severe consequences! The United Nations and many developed nations recognize female genital mutilation / cutting (FGM/C) as an illegal practice as well as violation of human rights as it unleashes both short-term and long-term negative effects on both the psychological and physical health of girls and women through its procedures which involve the rudimentary and painful partial or total removal of external female genitalia that always cause other form of injuries to the female organs and critically and terminally impairs a woman’s sexual and reproductive functions including the ability for normal passage of both urine and menstrual blood. Indeed many young girls die during the act of genital mutilation or circumcision due to excessive bleeding and many who are so lucky to survive into womanhood still face death during births because of FGM related complications.

In Somalia where I work, for example, above 90 per cent girls and women aged 15 to 49 are victims of FGM with the multitude of supporters and practitioners claiming that this adherence to the local socio-cultural norms is a healthy source of female chastity, hygiene and breeds family respect. The general believe in many people is that the practice maintains women’s virginity and reduces excessive desire for sex and so circumcised girls are likely to be considered as faithful and improve the chances of marriage and fertility. Just like many protagonist societies, the FGM practice in Somalia enjoys very strong moral, social protection and support from religious leaders, elders, family heads and even extended family/clan lineages. Among the Somali population, these very deeply-rooted cultural and social beliefs existing in the defense of FGM continue to dominate and defeat major efforts by any liberal government, civil society and/or non-governmental advocacy groups to discourage or criminalize the various forms of FGM practices leading to the lack of consent to develop laws and policies to stop FGM.

The controversies surrounding FGM or how to stop it has thus been a never ending struggle for Somali governments and civil societies as well. While the majority of faith-based groups and leaders are in favor of some sort of relaxation in the current practice, many governments’ institutions have made attempts to have it banned (zero tolerance). This so far has largely remained unconvincing for many key leaders and lawmakers. The advocacy for minor forms of FGM (type 1 or 2) expressed by some religious and traditional leaders is nowhere near to the ongoing efforts toward the zero tolerance.

The Zero Tolerance campaign  believes that medicalization of FGM will go against the Stop FGM movement as people will find ways to continue this practices at public and private medical institutions. Together with international agencies, civil societies and national governments, every citizen should continue to convince the decision-makers, whether government or religious institutions, to adopt strong political, legal and social measures to discourage FGM practices. I believe that the political leadership, support of religious institutions and coordination among international and the local civil society need to be harnessed to silence this practice and classify FGM as an offense.

As part of this global campaign, one of the many initiatives that we should add to the campaign is to advocate for one day leave in the beginning of monthly menstrual period for all female employees in non-profit, private and public sectors. The leave is given at the beginning of each menstrual cycle as commemoration of their self-reawakening and awareness of the detriments of FGM and their individual commitment as victims to our global Zero Tolerance campaign. It is not only an effort to help relieve their physical and mental pain (dysmenorrhea) in the beginning of monthly menstrual cycle but also to slow our solidarity and support to their fight against FGM.

We should encourage members of all global movement and all well-wishers to join particularly our mothers, women and young sisters in celebrating the beginning of each menstrual cycle for every female as a cherished sign of womanhood. At the same time we commit ourselves to fight against the practice for our future generation free from FGM. We want to envision every FGM-free and painless monthly menstrual period for every woman as special, free from daily chores and with the highest level of personal hygiene and physical rest possible for all. Our hope is that other institutions as well as our society will recognize this effort and work towards achieving a FGM-free society.

We are hopeful that as we stand side by side in this struggle, this day will not only continue to remind us all of the painful experiences women go through each day, but also challenge us to the collective resolve for Zero Tolerance to FGM across the globe.

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*Disclaimer: The views and opinions present in this article are my own and do not necessarily reflect the official position of my organization or institutions that I work for or associated with.

 

 

 

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Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Sesta Conferenza OMS Ambiente e Salute

…environmental degradation and pollution, climate change, exposure to harmful chemicals and the destabilization of ecosystems threaten the right to health, and disproportionately affect socially disadvantaged and vulnerable population groups , thereby exacerbating inequalities…. 
Sixth Ministerial Conference on Environment and Health, Ostrava, Czech Republic, 15 June 2017

by Daniele Dionisio

Membro, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

Responsabile del Progetto Policies for Equitable Access to Health – PEAH http://www.peah.it/

Sesta Conferenza OMS Ambiente e Salute

equità e condivisione 

 

Il governo della Repubblica Ceca ha ospitato nella città di Ostrava dal 13 al 15 giugno 2017 la Sesta Conferenza Interministeriale su Ambiente e Salute della Regione Europea dell’OMS.

La Conferenza è stata organizzata dall’Ufficio Regionale OMS per l’Europa, in partenariato con l’ United Nations Economic Commission for Europe (UNECE) e l’ United Nations Environment Programme (UNEP).

Le priorità e le sfide per la salute

Le motivazioni della Conferenza discendono dall’evidenza che circa un milione e mezzo di decessi ogni anno nella Regione Europea sono causati da rischi ambientali che potrebbero essere evitati e/o eliminati. E’, pertanto, indilazionabile la necessità di intensificare il contrasto ai determinanti ambientali nocivi alla salute. Come è noto, essi includono l’inquinamento dell’aria, inadeguati servizi idrici e igienici, prodotti chimici pericolosi, rifiuti e siti contaminati, e scompensi climatici.

I vincoli di bilancio degli Stati Membri, le disuguaglianze socioeconomiche e di genere, la crescita delle patologie non trasmissibili, l’invecchiamento delle popolazioni, e un inaudito tasso di migrazione fra e dentro i Paesi della Regione hanno esacerbato cumulativamente le criticità  accennate. I complessi rapporti fra fattori ambientali, biologici, demografici, economici e sociali richiamano perciò all’urgenza di rafforzare la capacità di resistenza delle comunità verso le pressioni fisiche, naturali e sociali del 21mo secolo.

Nel corso della Conferenza i rappresentanti dei  53 Paesi della Regione hanno articolato nuove risposte a queste molteplici sfide elaborando sull’evidenza che la salvaguardia dell’ambiente è essenziale alla sopravvivenza dell’umanità. In questo spirito, accenti forti sono stati assunti sulla valenza transfrontaliera delle sfide ambientali, sulla necessità di azioni mirate non solo a livello nazionale, ma pure in ambito subnazionale e urbano, sull’importanza di identificare e tutelare le fasce più vulnerabili, e sulla imprescindibilità di una ‘governance’ aperta alla partecipazione dei cittadini e degli operatori di settore.

Lavorare in partenariato verso obiettivi globali

La Conferenza ha abbracciato la missione di promuovere sinergie chiave per gli obiettivi di salute, benessere e ambiente inclusi nel Programma ‘Health 2020’ per l’Europa e nell’Agenda 2030 delle Nazioni Unite (UN) per lo Sviluppo Sostenibile.

Focalizzando, infatti, sulla creazione di ambienti favorevoli e di comunità resistenti (fra i temi cardine di ‘Health 2020’), la Conferenza ha inteso assegnare alla strategia europea per la salute e l’ambiente il ruolo di piattaforma di implementazione, nella Regione Europea dell’ OMS, per gli inerenti goals e targets compresi nell’Agenda UN 2030 per lo Sviluppo Sostenibile.

Dichiarazione ministeriale per un’Europa protesa al futuro

Al termine della Conferenza gli Stati Membri hanno condiviso e siglato una dichiarazione comprensiva di un piano d’azione per la sua implementazione e dell’impegno di misurare e riferire sui progressi specifici attraverso i ‘reporting’ nazionali previsti per la verifica dei Goals di Sviluppo Sostenibile (SDGs) dell’Agenda UN 2030.

In armonia con lo spirito ed i contenuti della Conferenza, la Dichiarazione insiste sulla necessità che equità, inclusione sociale e uguaglianza di genere informino le politiche per l’ambiente e la salute, sull’urgenza della transizione da energie fossili a rinnovabili,  e sull’assoluta esigenza di tecnologie pulite e sicure, incluse soluzioni di ‘bassa emissione’ nei trasporti, nel contesto di un ridisegno coerente degli spazi e agglomerati urbani.

Particolare enfasi è posta dalla Dichiarazione su azioni chiave quali ‘sine qua non’ per il conseguimento degli obiettivi:

– miglioramento della qualità dell’aria  in linea con le linee guida OMS

-accesso universale, equo e sostenibile ad acqua potabile e  igiene personale e ambientale per tutti e in tutti gli ambiti

-lotta agli effetti tossici dei prodotti chimici mediante sostituzione con alternative accettabili, con stretta attenzione alle fasce più giovani e indifese

-sviluppo di programmi nazionali per l’eliminazione delle malattie legate all’asbesto

-espansione di  ambienti ‘tobacco smoke-free’, con particolare riguardo alla minore età

-prevenzione  ed eliminazione degli effetti nefasti dello smaltimento dei rifiuti, e delle connesse diseguaglianze

-applicazione in concreto dei principi e delle risoluzioni dell’Accordo sul Clima di Parigi 2015

-implementazione di coerenti ed efficaci politiche attraverso multipli livelli di ‘governance’, trasparenti assunzioni di responsabilità e migliori pratiche da parte delle leadership

-perfezionata  sostenibilità ambientale dei sistemi sanitari, inclusa la gestione dei rifiuti in termini di ridotta contaminazione esterna, oltre all’uso oculato e responsabile delle necessarie risorse e fonti energetiche.

Appropriatamente, il documento sostiene che le risoluzioni e azioni ‘ad hoc’  non possono esimersi dall’ adozione di mentalità e prassi  cooperative e multi-partecipative tese a migliorare, su base intersettoriale, la coerenza, la trasparenza, la coordinazione e la volontà collaborativa dei decisori a tutti i livelli al fine di scongiurare il rischio di duplicazione e frammentazione delle iniziative.

 

PER APPROFONDIRE

WHO Regional Office for Europe http://www.euro.who.int/en/home

United Nations Economic Commission for Europe (UNECE) https://www.unece.org/info/ece-homepage.html

United Nations Environment Programme (UNEP) http://www.unep.org/about/

Health 2020 http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being

United Nations 2030 Agenda https://sustainabledevelopment.un.org/post2015/transformingourworld/publication

Sixth Ministerial Conference on Environment and Health http://www.euro.who.int/en/media-centre/events/events/2017/06/sixth-ministerial-conference-on-environment-and-health/read-more

Declaration of the Sixth Ministerial Conference on Environment and Health http://www.euro.who.int/__data/assets/pdf_file/0007/341944/OstravaDeclaration_SIGNED.pdf

 

 

 

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