Africa

By Jens Berggren
STOCKHOLM, Sweden, Mar 21 2019 (IPS)

Every year, the World Economic Forum asks some 1,000 decision-makers from the public sector, business, academia and civil society across the globe to assess the risks facing the world over the decade to come.

Since 2012, water crisis has consistently been ranked as one of the threats with the highest potential impact as well as likelihood.

This year “water crisis” is named as the risk with the fourth biggest impact. When asked how likely the risks are to occur, “water crisis” is placed as number nine.

The top scores on both impact and likelihood are perceived to be: extreme weather events; failure of climate change mitigation nd adaptation; and natural disasters.

Jens Berggren

But wait a minute – what are extreme weather events, poorly managed climate change and natural disasters? Almost always the answer is water.

Of the 1,000 most severe disasters that have occurred since 1990, water-related disasters accounted for 90 per cent. With extreme water and weather events increasing in both frequency and severity in the wake of climate change, floods and droughts are set to strike harder and more often in the years to come.

Annual flood losses in Europe are expected to increase fivefold to 2050 and up to 17-fold by 2080.

Water doesn’t have to create a disaster to be a problem.

The sheer uncertainty around the future water availability is causing planning problems for cities, businesses and households. Shall we invest in expanding our water supplies or our stormwater drains or both? Should farmers invest in draining or irrigation? Does your home insurance cover both wild fires and mud slides?

During last summer’s heat wave in Sweden, fans were out of stock almost everywhere, reportedly creating a second-hand market where 50 SEK fans sold for 1,500 SEK. Will fans be the hot item in 2019 as well or will rainwear be the coolest thing around?

On closer inspection, 9 of the 10 risks with above average impact and likelihood have clear linkages to water.

Apart from the already mentioned, poor water governance too often plays a part in “man-made natural disasters”, “large-scale involuntary migration”, “interstate conflict” and “failure of regional or global governance”, as well as “bio-diversity loss and ecosystem collapse” where populations of freshwater species have declined by an average of 83 per cent over the last fifty years, far more than species on land or in the sea.

No one interested in managing risks can afford to ignore the role of water management.

So, what can be done?

Firstly, we need to understand that water risks are much more than its absence. Water is used by everyone, everywhere for almost everything.

Changes in its availability will have huge impacts on how we live and make a living. Ignoring the increasing water variability is a sure way, both figuratively and literally, to so called “stranded assets” – investments that become obsolete due to events rather than age.

We all need to apply the understanding of the role that water plays in our societies to policies and incentives in and by almost every sector and actor.

The big question we need to ask is: are our governance structures suited to the current and future realities of water? Are we being guided to use the water that we sustainably can borrow from nature as effectively as we can?

And are we sufficiently supported in our efforts to protect our loved ones, our lives and our livelihoods from the less benevolent aspects of water?

If not, now is the time to start discussing this with our peers and our leaders.

Despite the challenges I am optimistic. Yes, adapting our societies to new water regimes are daunting tasks. But we have three great things working in our favor.

The first is, somewhat paradoxically, that the world has neglected water challenges for so long. This means that there is still a lot of low-hanging fruits, good innovative solutions and plenty of unused tools in our tool boxes.

The second is that water tends to foster collaboration as we are often simply sit in the same boat.

The third is that water underpins progress and development in so many other sectors and vice versa. By acting to improve how we use, manage and protect ourselves from water, there is likely to be gains of different kinds also with regards to poverty reduction, nutrition, health, manufacturing industries, our seas, energy sector, conflict prevention etc.

It will not always be easy, but I am sure that together we can find tools for all the different water situations so that water will continue to be a source of life, peace and prosperity.

The post 9 of the 10 Worst Global Risks are Linked to Water appeared first on Inter Press Service.

Excerpt:

Jens Berggren is Spokesperson & Advisor at the Stockholm International Water Institute (SIWI)

The post 9 of the 10 Worst Global Risks are Linked to Water appeared first on Inter Press Service.

Some consumers had complained about unwanted side-effects, prompting the authorities to investigate.

Nigeria under-20 coach Paul Aigbogun would welcome Arsenal teenager Folarin Balogun to his squad but has not spoken to him about switching national allegiances.

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By Fahad Ferdous
DHAKA, Bangladesh, Mar 21 2019 (IPS-Partners)

(UNB/IPS) – Bangladesh is collecting data on international transactions of multinational companies to stop them from siphoning off money from the country.

Dhaka ranked second in South Asia by Washington-based Global Financial Integrity (GFI) in terms of illicit outflow of money. Some $5.9 billion was siphoned out of the country in 2015 through trade mis-invoicing.

The Transfer Pricing Cell of the National Board of Revenue, the revenue collecting authority of Bangladesh, has prepared a list of companies and is collecting data on priority basis. NBR sources said the cell will mainly collect data from the important offices and prepare separate files for each of them.

Transfer price is the price at which divisions of a company transact with each other for goods or services. It usually takes place when two related companies or two subsidiaries controlled by a parent, engage in international trade with each other.

But sometimes, high prices are shown for an imported product or service to evade taxes. This illegal practice is known as ‘transfer mispricing’. There are allegations that multinational companies are siphoning off billions of taka in the pretext of transfer pricing.

The NBR now has decided to collect data of multinational companies at its 9th board meeting. It will create separate tax profiles for the companies after completing audit.

On July 2, 2014, the NBR issued rules regarding transfer pricing under a provision incorporated in the Finance Act 2012. The Board took two years for framing the rule.

Some tax officials said it will be a time-consuming task. Initially, 921 companies operating in Bangladesh will be under the purview of their auditing, a senior tax official said..

In the preliminary stage, information about international transactions will be collected and the companies will be given a question paper. The next course of action will be decided after getting the answers, the official said.

The Deputy Commissioner of Taxes (DCT) may impose a penalty equivalent to a maximum one percent of the value of each international transaction in case of failure to keep, maintain or provide information, documents or records or comply with the notice.

A penalty of up to Tk 300,000 (USD 3,573) can be imposed by the DCT for failure in giving report by chartered accountants.

The post Bangladesh moves to stop siphoning off money by multinational companies appeared first on Inter Press Service.

Excerpt:

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Fifa bans Togo referee Kokou Hougnimon Fagla for life after finding him guilty of accepting a bribe to manipulate a friendly international.

Some of the US women legislators elected to office in November 2018

By Thalif Deen
UNITED NATIONS, Mar 21 2019 (IPS)

The dramatic increase in women legislators voted into office last November and the historic high of women candidates for the 2020 presidential elections have visibly changed the male-dominated political landscape in the US.

The reasons for the transformation include a growing new political power structure; the rise of gender empowerment; the widespread impact of the #MeToo Movement against sexual abuse; and perhaps, most important of all, a backlash against US President Donald Trump’s steady stream of public insults denigrating women as “bimboes”, “dogs” “fat slobs,” “disgusting animals” and “having low IQs”.

At the November mid-term elections, a record 102 women won seats in the US House of Representatives and 10 won in the Senate, for a total of 112 women — the most ever to serve in the US Congress.

Jody Williams, the 1997 Nobel Peace Prize Laureate and chair of the Nobel Women’s Initiative, told IPS: “As a US citizen and an activist promoting women’s rights everywhere, like many, I was pleased with the outcome of the 2018 mid-term elections”.

“In my opinion, Mr. Trump’s bombastic misogyny did influence this outcome, both in the numbers of women who decided to run for office in the various elections across the country, and also in the voting that brought so many women into office,” she declared.

“I think it is also the result of women recognizing the changing power structures – even if too slow for many – and deciding to use their individual power to add momentum to those changes,” Williams added.

In its 2018 annual survey of parliamentarians worldwide, the Inter-Parliamentary Union (IPU), based in Switzerland, rightly pointed out last week that the November elections in the US were apparently “historic” where diversity in women’s representation was particularly remarkable, with younger and more ethnically diverse women entering both the Senate and the House of Representatives– and for the first time.

Both the lower house (23.5 per cent of all representatives) and the upper house (25 per cent) included more women than ever before.

Of these, 37 per cent were women of colour, including the first two Muslim women and the first two Native American women.

The 2018 election also yielded the two youngest women ever to be elected to the U.S. Congress, both aged 29, as well as five new lesbian, gay, and bisexual parliamentarians (4 of them women).

Deb Haaland and Sharice Davids are the first Native American women elected to Congress while Rashida Tlaib and Ihlan Omar are the first Muslim women to represent their states in the House.

And, at 29, Alexandria Ocasio-Cortez and Abby Finkenauer are the youngest women to serve as US legislators.

Tlaib was born in the US to Palestinian immigrant parents, and Omar, who migrated to the US from a refugee camp in Kenya after fleeing the civil war in Somalia, is the first Somali American to serve in the US Congress.

Deb Haaland, a member of the Pueblo of Laguna tribe, is the first Native American indigenous woman elected to Congress, alongside Sharice Davids, who is a member of the Ho-Chunk Nation, a Native American tribe that hails from Wisconsin.

And there is also a historic number of women—six in all — who have formally declared their candidacies for the US Presidential elections scheduled to take place in November 2020.

They include four Senators: Kirsten Gillibrand of New York, Kamala Harris of California, Amy Klobuchar of Minnesota, and Elizabeth Warren of Massachusetts, along with Representative Tulsi Gabbard of Hawaii and Marianne Williams, an Independent candidate.

Sanam Aderlini, Founder & Chief Executive Officer (CEO) of the International Civil Society Action network (ICAN) told IPS “white supremacy” gained a significant boost in the US with Donald Trump’s victory.

His rhetoric and attitude towards women, particularly strong, independent women who challenge him, has always been vitriolic.

“And, of course, the fact that so much of it is directed at women of color is itself indicative of the ugly mix of racism and sexism that is at the core of these movements and ideology,” said Anderlini.

She pointed out that these extremist movements have very rigid interpretations of gender, and so sadly, the lesbian, gay and bisexual (LGBTQI) community is also typically targeted,

“What we are observing is the rise and spread of different forms of identity based extremism. These movements tap into visceral faith or ethno-racial identities. They also all have the subservience of women and the notion of hyper masculinity and patriarchy at their core”

With regard to women in particular, they seek to either co-opt women to support the movement, or coerce them to control them, said Andelini, who is also on the Commonwealth Panel of experts on Preventing Violent Extremism (PVE).

It is most evident, she pointed out, in the obsession with the control over women’s bodies – either in terms of their covering or in terms of their reproductive capacities.

“Because, they want to control women, they are particularly vitriolic towards women’s rights activists and movements, because they challenge the very essence of what extremist movements represent,” she declared.

Mavic Cabrera Balleza, Chief, Network of Women Peacebuilders, told IPS: “I would rather call it “Feminist movements redux” rather than “backlash” because it is inspired by the activism of feminists in previous generations”.

She said the plural in “movements” also represent the diversity and universality of the feminist ideology.

“I also believe that the election of more and unprecedentedly diverse women in US Congress during the 2018 mid-term elections is only partly because of President Trump.”

As you can see, she said, women are not only condemning the sexist and misogynist messages or demanding punishment for sexual abuses, they are also shining the spotlight and demanding response to issues that have been around for many years but have not been adequately acted upon–if at all.

These include migration, gun violence, universal health care, environmental degradation, wars and militarism –among others.

She said the phenomenal #MeToo campaign on sexual abuse against women has given rise to #Time’s Up, #Niunamenos, #NotOneMore, #BalanceTonPorc, #TotalShutDown, and other campaigns.

“My greatest hope is that the results of the 2018 mid-term elections in the US will resonate around the world as different countries are experiencing or are threatened by authoritarianism”.

“I want to see successful non-violent resistance movements across the world within the next decade. I and my colleagues in the Global Network of Women Peacebuilders are actively contributing towards the realization of this vision,” Cabrera Balleza said.

Anderlini told IPS the overlap or mutually beneficial transactional relationship between the white right and the evangelical movement is not a coincidence either.

“We see it in the Trump-Pence duo,” she noted, referring to Trump’s Vice President Mike Pence.

“Precisely because they target and seek to control women, women were the first to mobilize and speak out and resist. This happens in every country I know – from 1979 Iran, when the Islamists sought to impose the hijab and 100,000 women marched in protest, to Washington DC in 2017 and the million women march”.

The mobilization of women into the political sphere is an extension of these developments, Anderlini said.

In many other countries, the pathway to power is blocked for women so they sustain their activism in civil society.

In the US luckily, there are more opportunities. It is also because of years of work by groups such as Emily’s List and others encouraging and supporting women to run for office, she declared

http://www.icanpeacework.org/wp-content/uploads/2019/03/AnderliniKeyNOTE-March-1.pdf

The writer can be contacted at thalifdeen@ips.org

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All the details of the draw for the quarter finals of the African Champions League and Confederation Cup.

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Kenya's Lake Victoria fishermen are struggling to compete with cheap Chinese fish imports.

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Maths and physical science teacher Peter Tabichi (far right) in class. The Keriko Mixed Day Secondary School teacher has been nominated for the one million dollar Global Teacher Prize. Courtesy: Peter Tabichi

By Busani Bafana
BULAWAYO, Zimbabwe, Mar 20 2019 (IPS)

Keriko Mixed Day Secondary School in Nakuru County, situated in a remote, semi-arid part of Kenya’s Rift Valley, could pass for an ordinary secondary school in any part of Africa. But ordinary it is not.

Maths and physical science teacher Peter Tabichi’s love for science is changing the lives of Keriko’s 480 students for the better.

In a region frequently blighted by drought and famine, Tabichi’s students come from poor families–almost a third are orphans or have only one parent–with many going without food at home. The students have mixed experiences from drug abuse, teenage pregnancies, early school dropout, young marriages and there have been cases of suicide.

Keriko Mixed Day Secondary School reflects the challenges of education access in many parts of sub-Saharan Africa; lack of teaching and learning resources, high student to teacher ratios, high drop-out rates and teacher demotivation.

According to the United Nations Education and Scientific Organisation (UNESCO), of all regions, sub-Saharan Africa has the highest rates of education exclusion, with over one-fifth of children between the ages of about 6 and 11 not attending school.

Further, the UNESCO Institute for Statistics (UIS) data states that almost 60 percent of youth between the ages of about 15 and 17 are not in school. The organisation warns that without urgent action, the situation will likely get worse as the region faces a rising demand for education due to a still-growing school-age population.

Filling the education gap with science

Tabichi, a member of the Franciscan Brotherhood, donates 80 percent of his monthly income to help his students in need.

But it is his dedication and passionate belief in his students’ talent, that has embolden the poorly-resourced learners to take on Kenya’s best schools in national science competitions.

Through his mentorship, Tabichi’s students participated in the 2018 Kenya Science and Engineering Fair where they displayed an invention that allows blind and deaf people to measure objects.

Keriko Mixed Day Secondary School came first nationally in the public schools category competition organised by the science fair. The maths and science team qualified to participate at the INTEL International Science and Engineering Fair in 2019.

Using the school’s only computer, and despite the poor internet connection and a student-teacher ratio of 58:1, Tabichi has impacted his student’s impoverished lives. He started a Talent Nurturing Club and expanded the school’s Science Club, helping pupils design research projects that are of such a high standard that 60 percent of them now qualify for national competitions.

“My four colleagues and I also give low-achieving pupils one-to-one tuition in Maths and Science outside class and on the weekends, where I visit students’ homes and meet their families to identify the challenges they face,” Tabichi told. “I use ICT in 80 percent of my lessons to engage students, visit internet cafes and cache online content to be used offline in class.”

In February 2019, Tabichi was named one of the top 10 finalists for the Varkey Foundation’s Global Teacher Prize 2019. The one million dollar award recognises an exceptional teacher who has made an outstanding contribution to the profession and highlights the important role of teachers.  Tabichi and nine other finalists were selected from over 10,000 nominations and applications from 179 countries around the world.

The Global Teacher Prize was established five years ago and aims to recognise the exceptional work of teachers all over the world.

Tabichi is excited about his nomination for the prestigious award, describing it as a God-given honour.

“I did not anticipate it,” Tabichi, told IPS. “But I feel that I deserve it since I have transformed the lives of many students. Also, the nomination makes me view all the hard-working teachers throughout the world as superheroes that the world needs to give recognition for bringing a positive change to society.”

Turning challenges into opportunities

Raised in a family of teachers, Tabichi said he recognises the great contribution teachers bring to their communities through their dedication and passion. He added that he was inspired by his father to perceive a teacher’s role as that of enlightening others on how to tackle the challenges of life.

On what can be done to make education, especially at early and primary level accessible to all, Tabichi believes that making it free, equitable and raising the quality of education is a start.

Asked what he will do with the Global Teacher Prize, should he win?

“The main focus will be on the community and school. For example, I would strengthen the Talent Nurturing Club, the Science Club and inter-school science project competitions,” said Tabichi. He added, “I would also invest in a school computer lab with better internet connectivity. In the community, I would promote kitchen gardening and production of drought tolerant crops.”

Congratulating Tabichi for his nomination, Founder of the Varkey Foundation and the Global Teacher Prize, Sunny Varkey hoped Tabichi’s story would inspire those looking to enter the teaching profession.

“The thousands of nominations and applications we received from every corner of the planet is testimony to the achievements of teachers and the enormous impact they have on all of our lives.”

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Message by the Executive Director of the Geneva Centre for Human Rights Advancement and Global Dialogue (“The Geneva Centre”) Ambassador Idriss Jazairy

By Geneva Centre
GENEVA, Mar 20 2019 (IPS-Partners)

(Geneva Centre) – The 2019 International Day for the Elimination of Racial Discrimination and this year’s theme devoted to tolerance, empathy towards the Other and celebration of diversity, comes at a timely moment.

We are witnessing a populist tidal wave deriving from the disruptive effects of a phenomenon of globalization without a human face, lacking a moral compass. Populist parties are strengthening their presence in numerous countries, becoming mainstreamed in the political landscape and bringing in their wake increasingly tumultuous waves of xenophobia and ethnic discrimination, particularly targeted at people of Arab and African descent. The situation is prone to explosions of violence by the hostile pronouncements of some world leaders or by a mere state of denial entertained by the latter.

The messages of these populists and extremists are furthermore based on deliberately distorted interpretations of religious teachings to install hate, fear and prejudice, thereby critically jeopardizing social harmony and exacerbating marginalization and repression of minorities based on religion or ethnicity. Such messages are fomenting divisiveness and dangerous myths, instigating hostility and violence.

In parallel, racial discrimination has been exacerbated by the continuing and widening gap between the elite and the lower income groups, institutionalizing social stratification and subsequent societal fracture.

As global citizens, we cannot turn a blind eye to the increasing spread of hatred and discrimination resorted to as an attempt to seize or consolidate political power. There is a pressing need to stand up to these dangerous forces that seek to distort societies that were once praised for their openness and tolerance towards diversity in the social fabric and pluralism as an underlying approach. This is a time for vigilance to fight against the rise of prejudice in an increasingly aggressive manner.

The Durban Declaration and Plan of Action against racism, adopted 18 years ago, remains valid today as it calls for a consolidated strategy to restore rights and dignity for all, taking into account recent trends and developments, to address this scourge with a view to its ultimate elimination.

A vital component of such a strategy would be to ensure universal recognition and respect of equal citizenship rights for all throughout the world. It was towards this end that the Geneva Centre organized a World Conference on 25 June 2018 on the theme of “Religions, Creeds and Value Systems: Joining Forces to Enhance Equal Citizenship Rights.” The conference sought to capitalize on the fundamental convergence of religions, creeds and value systems to mitigate the marginalization of communities worldwide with the goal of eliminating xenophobia and all forms of intolerance. The conference produced an outcome declaration aimed at moving towards greater spiritual convergence to support equal citizenship rights and resulted in a consensual global vision to promote this goal. The Geneva Centre will shortly be issuing a two-volume publication on the world conference.

The Geneva Centre wishes on this International Day for the Elimination of Racial Discrimination to join hands with all those involved in such a noble endeavor.

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Excerpt:

Message by the Executive Director of the Geneva Centre for Human Rights Advancement and Global Dialogue (“The Geneva Centre”) Ambassador Idriss Jazairy

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Lorato Modongo at the “Speak Up, Speak Out: Young Advocates Advancing SRHR Through Storytelling” in New York, during the current 63rd sessions at the UN Commission on the Status of Women (CSW), March 2019.

By Lorato Palesa Modongo
GABORONE, Botswana, Mar 20 2019 (IPS)

This week, I joined thousands of activists, campaigners, thought-leaders, and change-makers in New York to advocate for women’s rights and promote gender equality during the 63rd session of the UN’s Commission on the Status of Women (CSW).

While many of the conversations will push for policies and programs at the global level, we must not lose sight that the work of dismantling patriarchy and gender inequality must also begin within our families and communities.

I was raised in a small village in Botswana called Palapye. Like many Batswana children, I was raised by my grandmother alongside 3 of my boy uncles and cousin. I was the only girl child in this houseful of boys.

I did everything with these boys. I played soccer on the streets with them. I climbed trees with them. I would fall and bruise my knees with them. I was carefree and naive. I never consciously saw myself as different from them. Until one fateful Saturday morning.

I was 8 years old. My grandparents had left for another village and wouldn’t be returning until a day later. In their absence, we did what most children do with newfound freedom. We ate what we wanted including the rice and meat that was reserved for Sundays. We let a heap of dishes pile up in the sink.

As the day went on, the place became a mess. We didn’t bother with any broom or mop. How could we? We were glued to the TV–watching whatever channel we desired. There was no adult policing us to say, “But that is for adults! Watch cartoons instead!”

When my grandparents came back the next day, my grandmother (May she rest in power), nearly had a heart attack at the sight of the messy state of her house. “Le thakathanktse ntu yame jaana, naare la tsenwa?” she exclaimed in Setswana. “Why have you messed up my house like this? Are you all crazy?”

Silence.

Our eyes darted about with no proper explanation. My grandmother continued, “Lorato! Ke a go botsa!” Lorato, I am asking you! I paused. Why was I being singled out to answer this question?

So, with my notorious loud mouth I asked, “Why me when they all created this mess?” “Because you are the girl,” she responded.

I protested of course. The person who should be responsible for this is my older 15-year-old uncle, since in my 8-year-old mind, older people had to be the responsible ones. My protest sort of worked. I didn’t have clean the dishes. But my uncles did NOT clean up either.

Lorato Modongo (second from left) runs Teen Lead in Botswana. The project mentors high school students about leadership, personal development, consent and Sexual and Reproductive Health Rights.

It was my grandmother who did what she did every day–all the chores.

This moment was my first introduction to gender roles. It was my first memory where I came to realize that girls and women must physically labor in their households. I realized that my beloved grandmother labored daily for us not because she was older, but because she was the only woman in the house.

And here I was, at age 8, being recruited and positioned for that same role.

Since then, I became more aware and conscious of the many inequalities in my world that were rooted in gender differences. In the classroom, for example, I noticed how as girls we had to act “more appropriately.” We had to tone our voices down and not go galaotega – to not speak on loudspeaker.

I noticed how when puberty hit, our developing breasts were a source of embarrassment. Our periods had to be talked about in hushed voices. We had to hide our sanitary pads. Our legs. Our legs had to be closed because respectful women close their legs.

Also, if you do not close your legs, men will see your thighs and they would want to see what is between your thighs. And no one will believe you because what business did you have, not covering your juicy, near ripe 15-year old thighs?

I noticed on National TV and newspapers and school books how there was little or no representation of women leaders in all kind of spaces in my country. I read history books about all the great leaders. Not a single mention of any African woman.

I witnessed inequality in everyday life: in education, in access to health services, in transport, in political power, and in the microcosm of family life. But it clicked and became more clearer when I was recruited to participate in research project during my 3rd year at University of Botswana.

During this project, we explored access to sexual and reproductive health and rights (SRHR) services for young girls like me. We explored how girls showed up in my world.

Hushed.

Invisible.

Respectful.

Nice.

Ambitious but with a limit.

Aware of self, but not too self-aware so as to not scare men off.

We explored how the world showed up for girls like me: With violence and rage and policing.

We explored our reality. The prevalence of sexual violence and rape and all types of violence upon our bodies. Although gender-based violence is prevalent across the world, in Botswana, over 67 percent of women have experienced abuse—which is double the global average. Research shows that 40 women are raped each week in the country.

We explored the policies and laws that sought to either protect us, or further our plight in the patriarchal society. We explored all this and own existence and agency in the world.

I better understood how access to SRHR and agency over women’s bodies are all linked to gender inequality. But it all began when I was 8. Access, or lack thereof, to SRHR services is linked to a need to police, dominate, and control women’s bodies.

Until we don’t dismantle patriarchy and gender inequality at the core within a family and community, we will not make progress at a societal, national, or global level.

In the words of Tapiwa Mugabe, “My ancestors live and breathe vicariously through me.” Unlike my grandmother’s generation, I have the space to speak up and speak out.

Being here today, I know she would be proud. Her defiant, rebellious granddaughter who at 8 refused to clean the house, stands before you today at 29 refusing to accept how the world shows up for women like me, for women like us.

*Lorato Modongo was born and raised in Botswana. She earned a Mandela Rhodes Scholarship to pursue a master’s degree in Research Psychology. She is also a Women Deliver Young Leader from the Class of 2013.

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Excerpt:

Lorato Palesa Modongo* is co-founder of Teen Lead Botswana, which offers training and workshops to high school students on gender-based violence, consent, Sexual and Reproductive Health and Rights (SRHR), and leadership development.

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Manoj K. Pandey is Lecturer in Economics, Australian National University; Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania; and Raghav Gaiha is (Hon. ) Professorial Research Fellow, Global Development Institute, University of Manchester

By Manoj K. Pandey, Vani S. Kulkarni and Raghav Gaiha
Canberra, Philadelphia and Manchester, Mar 20 2019 (IPS)

Depression is often distinguished from other non-communicable diseases or NCDs (e.g., cancer, diabetes, cardio-vascular diseases, hypertension) because of the stigma attached to it. Among other consequences, those suffering from depression are often denied access to medical care. Indeed, the latter is an outcome of interaction between supply of and demand for medical care. On the provider side, stigmatizing attitudes by service providers are identified as a barrier to access. On the demand side, stigma and low mental health literacy by community members are just as emphatically reported as barriers to accessing care.

Manoj K. Pandey

But there are striking similarities between depression and other NCDs too. There are strong inter-relationships between them (eg, between depression and cancer, depression and diabetes, depression and strokes).

Many NCDs share common risk factors such as tobacco use, physical inactivity, and unhealthy diets that are associated with cardio-vascular diseases (CVDs), diabetes, and cancer. The South African adult population has high levels of these risk factors, and large proportions of the disease burden can be attributed to these modifiable risk factors. Mental disorders increase the risk of all these diseases, which in turn increase the risk of mental disorders (Patel et al.2018 a).

Our recent study focuses on the association from depression to other NCDs, based on a state-of-art analysis of the five waves of the National Income Dynamics Study (NIDS) panel survey data for South African adults (30 years and above) for 2008, 2010, 2012, 2014, and 2016/17 (Pandey et al. 2019). NCD outcomes are the dependent variable with depression in the initial year and other explanatory variables that vary with time or do not. Examples of the former include age, wealth, whether living alone and affiliation to social networks, and of the latter gender and ethnicity. Although much has been written on the association from NCDs to depression, the research on the reverse association from depression to NCDs remains patchy. Hence the focus here is on the latter.

There are robust associations from depression to other NCDs in South Africa. With controls for socio-economic factors, the initial condition of moderate and severe depression is robustly associated with NCDs such as high blood pressure, stroke, heart diseases, cancer, and at least one NCD in subsequent years. This result is also consistent for mental health conditions where poor baseline mental health condition increases the risk of NCDs later. Moreover, the risk of NCDs is higher when severe depression or poor mental health conditions are present (with or without NCDs)—with a slightly larger risk when severe mental health conditions co-occur with an NCD in the initial year.

Vani S. Kulkarni

Although there is no evidence of a gradient between NCDs and wealth quartiles, there are a few striking contrasts. Relative to the wealthiest (in the top 25% bracket or 4th quartile), the least wealthy (bottom 25%/first quartile) are less likely to suffer from diabetes, high blood pressure, and stroke, while those in the second quartile show a lower risk of stroke. So the proposition that NCDs are diseases of affluence cannot be rejected outright.

Relative to the Africans, the Whites are less likely to suffer from diabetes but more vulnerable to heart diseases, cancer and at least one NCD. The Coloureds have higher risks of NCDs while the Asians/ Indians are more vulnerable to diabetes and heart related problems. At older ages, the proportion of black Africans is higher than it was previously which accounts for the decrease in lung cancer because black Africans have a lower rate of smoking than White and Coloured people. The South African Indian community is more insulin resistant than other ethnic groups and therefore at greater risk of diabetes type 2 and ischaemic heart disease.

The Lancet Commission on global mental health and sustainable development (2018) and WHO (2015) report adverse impacts on the health of the caregivers. Caring for a person with a chronic, disabling NCD or mental disorder, such as cancer or dementia, is stressful and associated with an increased risk of chronic health problems, including depression, hypertension, sleeping problems, and fatigue; increased use of psychotropic drugs; and premature mortality. Indeed, such indirect impacts on caregivers, who are often members of the patient’s household, result in sick households.

The Mental Health Care Act 17 of 2002 in South Africa requires that service users undergo a 72-h emergency management and observation period for involuntary admissions to designated general district and regional hospitals across the country, before they are referred to specialist psychiatric hospitals. However, implementation remains daunting, with inadequate infrastructure and specialist staff. Indeed, several studies are emphatic that this requirement has negatively affected the quality of care provided (Petersen et al. 2017).

Raghav Gaiha

A policy shift from a singular disease focus to individual patient as one unit is needed. In the South African context, for example, diabetes and depression are separated within the health-care institution so that someone with depressive symptoms during routine diabetes care does not simultaneously get medical attention for the former. Of particular importance is integration of depression and NCD care in primary health care with a view to increasing prevention, screening, self-management, treatment and rehabilitation in order to achieve equitable, efficient and quality health services in South Africa. Arguably, simultaneous medical care for mental disorder and other NCDs also has considerable potential for overcoming the stigma of a mental disorder. However, the integration has been impeded by lack of trained doctors and nurses, essential equipment, its poor maintenance, and adequate funding.

A case could be made for substantially higher investment in primary health-care systems (Patel et al. 2018 b). On the supply side, these investments include greater accountability of services to local communities, enhanced sensitivity of providers to local conditions and beliefs, and provision of care to the needy. On the demand side, effective local services can address complex problems of patient access, offset the financial burden of adult chronic illness, and restrict unnecessary use of expensive private care. Although additional resources are needed, the magnitude is likely to be less than projected if the efficiency of investment in primary medical care is factored in.

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Manoj K. Pandey is Lecturer in Economics, Australian National University; Vani S. Kulkarni is Lecturer in Sociology, University of Pennsylvania; and Raghav Gaiha is (Hon. ) Professorial Research Fellow, Global Development Institute, University of Manchester

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