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The US Cellular Telecommunications Industry Association Looks at “Healthcare Everywhere”

 

In the hallways of the Las Vegas Convention Center, where the US Cellular Telecommunications Industry Association (CTIA) annual gathering took place last week, cool apps, shiny gadgets, the 4G network and machine-to-machine (M2M) opportunities were dominating discussions.  But a closer listen revealed a growing conversation about how the wireless industry is using its networks and devices to transform healthcare.

An afternoon session, “Healthcare Everywhere”, organized by MobiHealthNews gathered venture capitalists, mobile operators, device manufacturers and healthcare companies to lend their perspectives on the wireless health market, which is projected to double in size next year.  The presentations focused largely on opportunities in wealthy countries, but the rationale and incentives cited apply in emerging markets as well.

In the U.S., for example, where 75% of healthcare costs result from chronic diseases, mobile health (mHealth), holds the promise of introducing a consumer-focused model of health services that, in the words of University of Pittsburgh Medical Center Chief Innovation Officer Jay Srini, encourage a more “proactive, participatory, preventative and predictive” way of addressing health needs.

In emerging markets where chronic health conditions like diabetes and obesity are on the rise, the “4 Ps” advantage of mHealth also hold tremendous promise for advancing the health-related UN Millennium Development Goals of reducing maternal mortality, improving children’s health and tackling specific diseases like HIV/AIDS.   Particularly in remote areas where access to hospitals or doctors is limited, low cost mHealth interventions can play a significant role in closing the health services delivery divide.

For example, a low cost mobile-compatible USB ultrasound probe enables remote health workers to capture and transfer images of fetuses even in the absence of hospital infrastructure.  And CellScope, a prior winner of the Vodafone Americas Foundation’s Wireless Innovation Project, can transform a cell phone into a microscope, enabling diagnoses at the ‘point of vision’.

Stay tuned for more flashpoints in mHealth innovation when the winners of the 2010 Wireless Innovation Project and the new mHealth Alliance Award are announced in April.

Whether in wealthy countries or emerging markets, the opportunity of mHealth offers a future of engagement and empowerment.  The conversation will continue at the mHealth Alliance and FNIH-organized mHealth Summit November 8-10 in Washington, D.C.

Adele Waugaman directs the UN Foundation & Vodafone Foundation Technology Partnership and manages communications for the mHealth Alliance.

 Image: Flickr (UN Foundation)

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Democratic Republic of Congo: a new strategy for the UN?

Yesterday, in a new report, Human Rights Watch condemned the Lord’s Resistance Army (LRA) for its December 2009 killing of “at least 321 civilians, abducting 250 others, including at least 80 children, during a previously unreported four-day rampage in the Makombo area of northeastern Democratic Republic of Congo.”

The massacre, first reported by the BBC, is yet another blow to the security situation in the Eastern DRC. This massacre by the LRA in the farthest northeastern reaches of the country creates additional stresses for the UN peacekeeping mission in the DRC (MONUC). The LRA, which was originally based in Northern Uganda and fueled years of violence and conflict there, has evolved into a transnational threat, with reports of LRA activity in Sudan, the Central African Republic and the DRC. While MONUC is the single largest peacekeeping operation in the world, it has to contend with complex conflict dynamics over vast swaths of land.

In addition to the Congolese rebel groups operating in the area, cross border guerillas like the LRA from Uganda and the FDLR from Rwanda, the Congolese army (FARDC) – which is supposed to work with MONUC on improving the security situation – has also been found responsible for committing acts of violence against civilians. A recent UN report found that “in North Kivu, an assistance provider for victims of sexual violence recorded 3,106 cases [of sexual violence] between January and July 2009; half of these cases were perpetrated by FARDC members.”

I suppose this shouldn’t be surprising, given that many FARDC troops are former rebels…

With nearly daily reports of violence, this region has been plagued with unacceptable levels of violence against civilians for more than a decade. The UN’s presence has unquestionably stymied the conflict, and analysts believe that MONUC’s continued presence is absolutely necessary.

MONUC has about 1,000 peacekeepers in this northeastern area of the country; according to Human Rights Watch, this is far too low a number to deter or prevent further attacks on civilians. The UN special representative of the secretary-general in the DRC, Alan Doss, told the BBC that rooting out the LRA “requires better intelligence gathering, requires particularly air mobility, and of course cooperation with the local people.”

Meanwhile, in spite of the continued, chronic violence plaguing his country, DRC President Joseph Kabila is hoping to see the backs of the UN peacekeepers as soon as possible. Members of the UN Security Council have diverging points of view on the matter. While the U.S. and France support continued engagement, China endorses the Congolese view that there will be “no new beginning for Congo as long as MONUC is there.”

It seems, however, that what the Eastern DRC needs is more and better UN peacekeeping, not a withdrawal of the mission. The country’s own armed forces cannot be trusted to protect the people, several local and transnational rebel groups are still at large, committing atrocities on civilians: as Mr. Doss suggested, now is the time for a better, reinforced strategy for the UN mission in DRC, not its departure.

Image: Flickr (UN PHOTO)

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Shaking Hands with Gulbuddin Hekmatyar

Representatives from Hezb-i-Islami, the smallest of Afghanistan’s three major insurgent groups, met with the Afghan president and the United Nations Assistance Mission this week to discuss a list of 15 conditions demanded in exchange for the group laying down its arms. Part 2 of the series.  (Part 1.)


 (KABUL) Compared to the opaque nature of the meetings between UN representatives and members of the Taliban (meetings the UN has confirmed but the Taliban still deny ever took place), the talks between Hezb-i-Islami, the Afghan government and the UN have been comparatively transparent –but only in relative terms. Journalists have struggled to wrest details afterward, and civil society has been shut out, angering progressive elements in Afghan society. Even most Afghan politicians have been forced to rely on the international media for updates.

 

Women, tellingly, have been completely excluded from the talks. In a March 8 interview with Eurasianet, leading human rights activist Palwasha Hassan bluntly said of Afghan civil society and its nascent women’s movement, “We have to be ready for a fight.” With the Hezb-i-Islami talks well underway, and women and civil society allotted a mere 50 seats in the peace conference scheduled for May, that fight looks to be a bruising one.

 

Afghanistan scholar Riccardo Redaelli described to The New Republic the effect granting legitimatized power to Hekmatyar would have on Afghan politics. “In the urban part of the civil society, it will be like a bomb that will destroy the image of the government.”

 

For good reason. In 1994, Hezb-i-Islami commander Gulbuddin Hekmatyar issued a series of decrees those unlucky enough to live in Hezb-i-Islami-controlled areas were required to obey. Among them were measures the Taliban later gained international infamy for continuing, including restrictions on the movement of women, the imposition of the burka, the prohibition of music, and medieval punishments for anyone caught violating Hezb-i-Islami’s warped version of Islamic law.

There are no indications Hekmatyar has softened his views in the sixteen violent years since, and the society Kabulis have built since late 2001 is one dangerously incompatible with that totalitarian vision.

Image: Flickr (UNAMA)

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State Department Touts Progress at the UN Human Rights Council

The UN Human Rights Council has made “incremental, but notable” progress since the United States joined the body last July according to Deputy Assistant Secretary of State for International Organizations Suzanne Nossel. Her remarks come as the council concluded its most recent meeting, which was the second formal council session in which the United States participated as a full fledged member.

You may recall that the previous administration opted to vote against the creation of the council and never sought to join it. Soon after taking office last year, however, the Obama administration announced that the Council would be a testing ground for its principal of engagement. “We have a record of abject failure from having stayed out,” UN Ambassador Susan Rice said at the time. “We’ve been out for the duration and it has not gotten better. It’s arguably gotten worse. We are much better placed to be fighting for the principles we believe in…by leading and lending our voice from within.”  Needless to say, formal council sessions are a good opportunity to test this theory.

One vote in particular sheds some light on how an actively engaged United States can change the dynamics of the council.

Every so often the Organization of the Islamic Conference (OIC) puts forward a resolution on the “defamation of religions.” The idea has gained steam since the Mohammed Cartoon controversy and, briefly stated, it condemns mocking religion and blasphemy. Western countries–quite rightly–consider this an infringement on freedom of speech and whenever the issue comes up for a vote western countries are pitted against the countries of the Organization for the Islamic Conference.The 56 member strong OIC tends to win these votes by fairly wide margins. The OIC both outnumbers western countries and, generally speaking, exerts more diplomatic effort to win the support of fence sitters in Africa and Latin America.

That was until last week. With the United States fully engaged in the process, the margin of victory for the OIC Defamation of Religions resolution dwindled to three votes compared to twelve votes it received in Human Rights Council just one year ago. There were also several shifts from abstentions to “no” votes among the Latin American and Caribbean countries and by South Korea and Zambia. According to Philippe Dam of Human Rights Watch, “these shifts seriously hinder the future of this OIC sponsored resolution.”   Suzanne Nossel described the changing dynamic around this vote as “significant progress.”

To be sure, the council is not without its flaws. Nossel criticized the council’s “excessive focus” on Israel and says the United States was trying to push back against what she called its “structural bias” against Israel.  Nossel pointed to Council’s actions on North Korea, Sudan, Congo (and at the United States insistence) Guinea as evidence that the Council is beginning to focus on more appropriate “country specific” work. 

The next session of the council will take place in June and Ambassador Rice’s theory will once again be put to the test. So far, though,iIt would seem that with a little bit of effort the United States is beginning to tip the balance at the council.

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The Bloody Hands of Gulbuddin Hekmatyar

Representatives from Hezb-i-Islami, the smallest of Afghanistan’s three major insurgent groups, met with the Afghan president and the United Nations Assistance Mission this week to discuss a list of 15 conditions demanded in exchange for the group laying down its arms.  Part 1 of a 2 part series about why these developments should be treated with extreme caution.

(Kabul:) The insurgent group Hezb-i-Islami (there’s an affiliated political party of the same name) is led by Gulbuddin Hekmatyar, arguably the most brutal Afghan warlord of the past 30 years.

During the first half of Afghanistan’s civil war in the 1990’s, Hekmatyar’s forces committed atrocities that elsewhere in the world are met with international arrest warrants and indictments for war crimes and crimes against humanity –not hints of future inclusion in government.

Hekmatyar’s fighters killed tens of thousands by deliberately shelling Kabul. They kidnapped, tortured, raped and killed countless civilians in ways so gruesome that many Afghans, especially Kabul residents, flinch at the mention of Hekmatyar’s name to this day. (An Afghan refugee once described to me Hezb-i-Islami fighters entertaining themselves by pouring hot oil on a freshly decapitated body to make it flail involuntarily.) When Hekmatyar was done with Afghanistan’s capital city, it looked like Hiroshima, and it will still be recovering decades from now.

In 1994, New York Times reporter Tim Weiner met Hekmatyar and described the attitude with which the militia commander approached butchering civilians:

Talking with Hekmatyar is like listening to wind chimes tinkling on the porch of a burning building. A disarmingly feline man, he purses his lips and talks dispassionately of the death of millions. His aim is to build “a true Islamic republic,” under his dominion, and he has the will and the weapons to fulfill that dream. If it takes another generation of war, so be it.

By then, Hekmatyar had presided over the killing of at least 10,000 people (for comparison purposes, that’s roughly the number of people killed in the Kosovo war). Hekmatyar’s body count is higher now, and still climbing. He’s never been indicted, and he probably never will be, but in the eyes of ordinary Afghans, he’s a war criminal unfit to live amongst his victims, let alone govern them.

It’s still unclear how exactly Hekmatyar would be brought into the Afghan government, but granting him any position of influence –and he wouldn’t likely settle for a symbolic post—would have a chilling effect on Afghanistan’s beleaguered democrats. Offering his deputies additional positions would be worse still. Hezb-i-Islami’s political wing is the most conservative in the Afghan government already, and while officially opposed to violence, it is also manifestly anti-democratic.

Among the demands made by the insurgent Hezb-i-Islami delegates in Kabul this week are presidential, parliamentary and provincial council elections in 2011 and the formation of a coalition government. If even some of these are acquiesced to, in violation of the constitution, Hezb-i-Islami could seize a greater share of power than it has now, by intimidating political challengers and voters, and rigging polls. If this happens, Afghanistan can expect the already low number of democrats and women in elected office to further dwindle.

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Niger: Can Political Changes Help Alleviate Food Crisis?

On Feb. 18, 2010, what has been referred to as a “textbook coup” took place in Niger. President Mamadou Tandja – who had been in power for more than a decade, was widely criticized for his poor management of a chronic food crisis in his country and for his lack of transparency – was ousted by Major Salou Djibo.

The military junta that took control of the country – calling itself the Supreme Council for the Restoration of Democracy – has been welcomed by many Nigeriens, who had been yearning for Tandja’s departure.

While the coup was condemned by ECOWAS and the African Union, which suspended Niger’s membership in the regional bodies, analysts took note of the local and international goodwill toward the junta. The readiness to trust the junta seems to hinge on the group’s willingness to pursue a rapid transition and prepare for democratic elections, as well as their apparent desire to distance themselves from the previous administration’s policy of denial and secrecy on social and economic issues.

Niger ranks dead last in the UN’s Human Development Index, a standard measure of well-being which encompasses life expectancy, education and GDP criteria. The country has been in the grips of a food crisis, which a recent government report estimates is having an impact on half of the population of 15 million.

The Red Cross has launched an international appeal for $1 million to be able to respond to this large scale crisis, and the junta itself has made an appeal for $35 million to fund the prevention and treatment of malnutrition. The country’s 812 health centers are currently staffed by just over 7,000 health workers; of these, 90% are in the capital, Niamey, leaving most of the other centers grossly under-resourced and unable to cope with the scale of the problem. 

Niger’s new leadership is acknowledging the seriousness of the food insecurity situation, in sharp contrast with the Tandja government’s habit of denying and attempting to cover it up. In spite of the positive steps taken by the junta, however, it is difficult to see how the food crisis in Niger can be alleviated in the short term. IRIN reports that, “the UN has estimated the cost of responding to the unfolding food crisis in Niger at $158.6 million.”

The international community is right to make the speedy restoration of constitutional rule a priority. Considering the alarming malnutrition situation, though, it is also imperative that the Nigerien leadership seeks ways to finance food-security initiatives.

In spite of Niger’s wealth of natural resources (it has the world’s third largest uranium deposit) and multi-billion dollar mining deals, Nigeriens have seen little improvement to their quality of life. Whoever is chosen to lead the country in the upcoming elections needs to be pressed – by the people of Niger and the international community – to utilize the country’s own vast resources to steer clear of what could be yet another major humanitarian disaster.

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