“The Jordan River has been the lifeblood of the Levant,” says Gidon Bromberg, the Israeli co-director of EcoPeace Middle East, in this week’s Water Stories podcast. The river’s importance offers a unique platform for multi-level conflict resolution and environmental conservation efforts
in a region wracked by conflict.
Following the 1993 Oslo Accords, “there was a sense of euphoria; we all thought that peace was about to break out completely,” says Bromberg, who helped found EcoPeace Middle East in 1994. “And the goal for creating the organization was the fear that the environment was not on the peace agenda, that fear that peace was going to lead to unsustainable development.”
When violence broke out once again, the bonds between the Jordanian, Israeli, and Palestinian members kept EcoPeace together. “We came to see…the model we had created in how to work together was actually a model for peace,” says Bromberg.
EcoPeace’s Good Water Neighbors program brings together residents of Palestinian, Israeli, and Jordanian communities to focus on their shared water sources, such as the heavily polluted Jordan River. “Communities came to see…that the only way to promote economic development in my community was to work with the other side, to develop relations and to move forward on a common agenda,” says Bromberg.
“We’ve found that youth are often braver than any other level of community interaction. From their perspective, if we need to work with the other side in order to solve this problem, then why aren’t we doing that?” he asks. For example, city mayors were persuaded to engage in water clean-up projects only after students requested it.
“I don’t want to paint a rosy picture: there is a lot of work still to do. But we have 100 years of conflict, and in just 10 focused years of peacebuilding [and] of advocacy, we’ve been able, through this multi-level intervention, change mindsets. Ministers and authorities that just several years ago were continuing to tell us that we’re dreamers, that we’re naive, that we’re wasting our time—today, some of them are the biggest advocates.”
“Almost everyone of reproductive age—about 4.3 billion people—will not have access to at least one essential or reproductive health intervention over the course of their lives,” said Patricia Da Silva, Associate Director, International Planned Parenthood Federation United Nations Liaison Office. She spoke at a recent Wilson Center event showcasing recommendations from the Guttmacher-Lancet Commission report, “Accelerate progress--sexual and reproductive health and rights for all,” on how to advance sexual and reproductive health from a human rights perspective.
The Commission presents a “comprehensive, evidence-based, and integrated vision of sexual and reproductive health and rights (SRHR) that recognizes that improving health depends on rights,” said Da Silva. Guaranteeing that all people, regardless of who they are or where they live, have access to “affordable, essential, and attainable” sexual and reproductive health services is a core pillar of the Commission.
Countries tend to focus on certain components of SRHR, such as improving access to contraception, HIV prevention, and maternal and newborn health services, but the Commission includes often neglected components of sexual and reproductive health, such as “abortion, infertility treatment, LGBTQI friendly services, youth friendly services, comprehensive sexuality education, as well as the prevention, detection, and management of gender-based violence,” said Da Silva.
Some key recommendations from the Commission include providing access to safe abortion services for all women, supporting changes in policies that enable all people to understand, protect, and fulfill their sexual and reproductive health and rights, ensuring universal access to an integrated package of sexual and reproductive health services, with a particular focus on reaching vulnerable populations, and finally, addressing sexual and gender-based violence through policy changes and prevention programs.
Existing gaps in access to sexual and reproductive health can create consequences not only for individuals and communities, but also for national economies around the world, said Da Silva. Investing in and ensuring access to reproductive services for all, primarily contraception, and high-quality maternal and newborn health services would result in a net savings of 6.9 billion dollars. “Spending money now, making corrective policy actions now, can save huge economic benefits for the future,” said Da Silva.
“The rights-based roadmap approach proposed by the Commission…it is the way to accelerate progress for SRHR. It is the way to achieve sustainable and equal development for all. And ladies and gentlemen, colleagues, the time is now.”
“When we start talking about water in the context of security, we’re immediately drawn to a conversation about conflict. And that’s often framed in terms of scarcity of water and a real zero-sum game around water, where scarcity begets grievances, which beget instability and conflict,” says Ken Conca, Professor at American University’s School of International Service, in this week’s Water Stories podcast. Of the world’s 276 transboundary water basins, fewer than half are governed by an agreement or accord that allocates use of the shared water between countries—and less than a quarter of these accords include all the riparian states in a basin.
“But when we step back, I think the larger frame is really one of uncertainty and of managing risks, and in that context, I think the good news is that there are a lot of cooperative opportunities,” says Conca.
Today, “we have a very weakly developed and patchwork body of international law. When you look at the content of that international law, we find that most of those agreements are actually fairly static, inflexible water-sharing agreements,” he says.
Conca points to some potential models for cooperation and collaboration: For example, the 1997 United Nations Watercourses Convention codifies several key principles that basin agreements should include to be equitable and effective: environmental protection, information sharing, and notice of infrastructure development, among others. “On one level it provides a very good framework,” he says, but “it doesn’t deal with a lot of the challenges of adaptation and resilience we face. So the challenge in international water law is really to create more flexible accords first.”
“We need to start doing the kinds of climate vulnerability assessments that the Paris Accords envisioned at the basin level,” he says, pointing out that national-level adaptation assessments don’t address shared water courses or dynamic flows across borders. “It’s critically important we start doing that sort of analysis.”
“We need to think less about allocating a fixed pie of water and more about expanding that pie through sensible and cooperative management,” says Conca.
“You cannot separate water and health,” says Doris Kaberia in this week’s Water Stories podcast. “People need safe drinking water for them to be healthy.” Kaberia works with Millennium Water Alliance, a coalition of international NGOs working on water sanitation and hygiene around the world, where she manages a Kenyan water program.
RAPID (Resilient Arid Lands Partnership for Integrated Development) “brings public-private sector partners…and governments together to manage water resources, particularly in the northern part of Kenya where water is really scarce.”
“There has to be calculation of water demand,” she says. “You match resource and the water demand. Otherwise there is always competition for water.” This holistic view is helping Kenya manage water resources for its more than 40 million citizens.
“We not only addressed the water-related shocks, but it was really integrated with health,” she says. RAPID improved water sanitation and hygiene conditions in northern Kenya, enabling health facilities to operate by ensuring they had clean water.
Public-private partnerships have proven valuable in Kaberia’s work. She says, however, that building partnerships was difficult, because “the way the development practitioners think, and the way private sector thinks, and the way governments think is totally different.” But if “you look at companies and industries, you will realize that most of the industries also need water for their manufacturing, for cooling of machines,” so you can connect with them on the shared needs. Kenya RAPID works with Coca-Cola, IBM, and Davis & Shirtliff, among others, to improve the sustainability of their interventions as they pursue their water development goals.
This interview was originally recorded in October 2016.
We realized “there was a need for a toolkit on water,” says Sandra Ruckstuhl in this week’s Water Stories podcast, “with a focus of conflict and conflict mitigation, but also peacebuilding.” Ruckstuhl, a consultant for the World Bank who has researched water programs in Yemen and the Middle East, helped the Wilson Center produce USAID’s Water and Conflict toolkit, which documents examples of successful development interventions focused on water and peacebuilding.
“We have lots of assumed peaceful outcomes from projects, but very little of it has been measured and documented,” says Ruckstuhl. “We would do a real service to the field if we really started documenting and measuring this kind of information so we can inform better and better practice in this area.”
Ruskstuhl and her team worked to ensure that the toolkit could be used by practitioners without professional training or formal education in conflict studies. “When we are talking about peacebuilding,” Ruckstuhl says, “we are boiling it down to collaborative governance—and that also is transferrable to different sectors.”
“When we are designing and implementing some development investment, we’re injecting ourselves into a system,” in which water management, health, food, and other public services are interconnected. Ruckstuhl calls for more incentives that would push practitioners to foster cross-sector connections, which would allow different sectors to work together more collaboratively.
Project designers must consider all the stakeholders involved, including governance institutions, which in many circumstances are dominated by men. “The constructive role women can play in the household, in these governance institutions, in the decision-making for things like water allocation…that knowledge and that capacity of women can be missed,” says Ruckstuhl. Integrating gender concerns more effectively would contribute to more equitable water management, so she proposes educating communities on the value of including women in projects focused on water and conflict.
“Countries—even countries that don’t like each other much—have, and continue to have, conversations over water resources, even when they won’t about other issues,” says Aaron Wolf, Director of Water Conflict Management and Transformation at Oregon State University, in this week’s Water Stories podcast.
Wolf’s research shows that water stress—instead of spurring wars between countries—can actually bring them to the negotiating table. “Water creates horrible suffering, human destruction, ecosystem degradation, and very, very little political violence,” says Wolf.
Tensions can rise, however, when an upstream country wants to build infrastructure (such as a hydroelectric dam) that would impact the people downstream. “It is not that the dam itself that causes the problem; it is the dam in the absence of an agreement about how to mitigate the impacts of the dam,” says Wolf.
Many treaties do not account for greater variability in flow arising from droughts or floods—both of which will be exacerbated by climate change. In the Middle East, “there are droughts that were so bad that the Israel-Jordan water agreement had nothing in text to deal with that. Fortunately, their relationship was solid enough that they could adapt based on their personal relations,” says Wolf.
To identify these gaps, Wolf and his team developed the Basin at Risk project, which provides a quantitative, global-scale exploration of the relationship between freshwater resources and conflict, as well as indicators to measure cross border tension. “With those verified indicators, we were able to look at basins in the next three to five years. Fortunately, most of those are no longer at risk precisely because the global community did what it does best—they help with the institutions, they help build the river basin organizations, and the treaties, and so on,” says Wolf.
“We need to mainstream young people into the decision-making process,” said Senator Nikoli Edwards, age 25, of Trinidad and Tobago at a recent Wilson Center event on engaging youth to protect their sexual and reproductive health and rights. “Where it’s not a matter of, ‘let’s bring a young person into the room as an afterthought,’ but it should be written that a young person has to be a part of the discussion or has to be contributing in a significant way.”
As a young person, “your expectations have been heightened, you have been encouraged to do all of this great work, but where are the institutions, where are the support mechanisms, where are the opportunities?” asked Edwards. The panelists unanimously agreed that high expectations for young people to serve and agitate for change have not been met with endless opportunities to engage.
Although many organizations have celebrated young peoples’ input, they still need to be more intentional about how they engage youth, said Cate Lane, Senior Technical Adviser at Pathfinder. Oftentimes, “we engage young people, we solicit their input, we ask them to tell us what they need and what they want,” she said. “We rev them up. They’re excited, and then we’re like, ‘thanks so much for your input,’ now we’re going to go implement our project.”
“When we are talking about youth participation, we should think about the diversity of young people,” said Dr. Ilya Zhukov, Global Focal Point for Comprehensive Sexuality Education at the United Nations Population Fund (UNFPA). Bringing key populations of young people, including LGBTQ+, HIV positive, and disabled youth, to name a few, together with decision-makers can ensure that health programming is informed by those it is meant to serve.
“When your opinion and your thoughts are influencing real documents that will then influence your education—that is a real thing,” said Lada Nuzhna, Youth Representative at Teenergizer!. Exchanges between young people and organizations working to promote adolescent health and rights should be a two-way street. “We need to see this not as a one-way street of us soliciting information from them, but as an opportunity for them to develop skills, networks, to gain access to things that they wouldn’t normally gain access to,” said Lane.
Adolescence is a dynamic period in life that can pose challenges to the longevity of youth project engagement. “If we engage young people, we can’t expect that they are going to be with us for the next five years because they are in school, they’re working, getting married,” said Lane. However, mechanisms such as youth advisory boards and councils could enable organizations to consult periodically with young people to ensure programs are responsive to their needs.
Experts agreed that a system to bring youth into the conversation on a regular basis is necessary to cultivate meaningful youth engagement, in addition to allocating resources—financial and human—to ensure that adolescent sexual and reproductive health programming is effective and responsive. “We should bring young people to the table and involve them not only in discussion but in the development and implementation of programs,” said Zhukov.
Governments, leaders of organizations and policymakers should continue to think about how to meaningfully engage with young people as partners. “I think it’s something we have to tackle,” said Lane. “There has to be this sense of partnership, where we meet each other in the middle.”
“Even in a weak system without a quality improvement structure, it is possible to support district managers and facility providers to measure and improve quality care,” said Eliane Razafimandimby, Chief of Party of USAID’s flagship Maternal and Child Survival Program (MCSP) in Madagascar, at a recent Wilson Center event on improving the quality of reproductive, maternal, newborn, and child healthcare (RMNCH).
Madagascar is currently in the early stages of improving the quality of its RMNCH care. After failing to meet the maternal and newborn Millennium Development Goals by 2015, the government created a roadmap to achieving the maternal and newborn MDGs by 2019 and mandated MCSP to support the Ministry of Health in strengthening its health system to reduce maternal and newborn mortality.
In order to have an impact on quality, “we needed to engage with the health system at different levels,” said Razafimandimby. A systems approach required emphasis on policy at the national level, capacity-building and data usage at the district/regional level, and targeted service-delivery support and community engagement at the facility level.
The ambitious task of assessing quality of care and implementing change involved nearly two-thirds of the country, across 16 regions and 80 districts. Quality care indicators monitored at more than 600 facilities showed promising reductions in maternal and newborn mortality.
Health facilities implemented preventative measures to improve quality. Having a newborn station in the operating room after a C-section allowed midwives to care for the baby without having to carry him or her to the neonatal unit for care, which was often located in another building. This small change facilitated more immediate newborn care as well as greatly reduced the risk of infection. Other improved outcomes were linked to significant increases in antenatal screening for preeclampsia and the adoption of postpartum family planning methods before discharge from a facility. “These improved outcomes were not only seen at the primary facility level but also at district and regional hospitals,” said Razafimandimby.
Despite success at the facility, district, and regional levels, national progress is slow. “Development of a national quality strategy and structure remains a high priority for Madagascar,” said Razafimandimby. “To be able to sustain and continue improvement work, national level leadership is really essential.”
“A lot of the advocacy of family planning has been built around establishing a long list of the many ways in which family planning can be relevant” to other development goals, says Parfait Eloundou-Enyegue of Cornell University in our latest Friday Podcast. While comprehensive accounts of the ways family planning access benefits communities, these “laundry lists” are not “clear, synthetic, or integrative,” he says.
Instead, Eloundou-Enyegue proposes that development planners focus instead on four “bottom lines” to more clearly communicate the importance of family planning across all sectors.
The first bottom line is financial: “Take people through the savings that they are going to achieve with each dollar that is invested in family planning,” said Eloundou-Enyegue.
The second bottom line is equity, which appeals to stakeholders who seek to promote justice in communities. Inequalities in fertility, income, and family structure “translate into very large inequality among children that will lead to even wider, larger inequality in the next generation,” Eloundou-Enyegue says. “Family planning can play an important role in breaking this intergenerational cycle.”
The third bottom line Eloundou-Enyegue proposes is durability, which appeals to visionary leaders through the dividends that family planning offers over multiple generations. In addition to the immediate benefits, there is a second dividend, when the current working age population reaches retirement with greater savings, and then a third dividend comes from greater investment in the early childhood development of the next generation.
The final bottom line is demand, particularly from youth: “There is actually a very large demand for family planning among youth if we return to the full meaning of ‘family planning,’” says Eloundou-Enyegue, focusing not just on births but on the course of one’s entire life. “Planning families for youth, and African youth, today, who are very concerned about their futures, is to think about how to plan their transition into work,” including developing skills and leadership.
“There is room there to incorporate family planning in a large vision which is concerned about planning futures, planning families, naturally, and planning lives,” says Eloundou-Enyegue.
Healthy Women, Healthy Economies is a global initiative that aims to unleash the “economic power of women by bringing governments, private sector, and other civil sector actors together to improve women’s health,” says Jocelyn Ulrich of EMD Serono, the U.S. branch of Merck KGaA, Darmstad, Germany, in our Friday Podcast. Providing for women’s health needs enables them to “join, thrive, and rise” in the economy, “bringing prosperity home to their families and communities.”
This partnership was established in 2014 within the Asia-Pacific Economic Cooperation (APEC) forum by the 21 APEC economies, led by the United States and the Philippines, and members of the private sector. The project sought to address significant barriers to women’s full participation in the workforce, which include non-communicable diseases related to reproductive health and the dual responsibility of the workplace and caregiving for children and elderly parents.
The partnership engaged in a comprehensive literature review and created a toolkit for governments and private sector actors to address these hurdles, with specific recommendations:
• Improve access to sexual and productive health services
• Increase awareness of services for voluntary family planning
• Provide high-quality maternal, sexual, and reproductive health services
• Protect against discrimination
Since 2015, the project has convened workshops to track progress against the toolkit’s policy goals. One of the advantages to working under the auspices of APEC is engaging high-level ministers in women’s health.
The toolkit’s policy recommendations align with the Sustainable Development Goals. “Sustainable economic growth really can’t be achieved if we’re leaving half of the population behind,” says Ulrich.