issue 3/16 the giz magazine health – getting better other topics: opportunities for start-ups in india a new home in afghanistan akzente
maina is developing business strategies for pharmaceuticals manufacturer merck in darmstadt. he intends to apply the experience he has gained once he returns to kenya. his stay in germany was made possible by ‘afrika kommt!’, a one-year scholarship programme in which german companies give young african managers an insight into their management methods. you can find more ‘faces and stories’ at www.giz.de/stories steve ngatia maina junior executive from kenya currently working in germany scan the code with your smartphone to watch the video. faces and stories ‘afrika kommt!’ has changed my life
editorial 3 akzente 3/16 dear reader, people in botswana are now living around 10 years longer than in 2000. rwanda, too, has made equally impressive progress on improving life expectancy. both countries have invested in their health sys- tems, established insurance schemes and worked hard in the fight against aids. these efforts have not only benefited each and every individual but have also boosted the re- silience of the countries as a whole. a comprehensive and well-performing health system increases security and stability, as the german government recently pointed out in its white paper on security policy, which identifies epidemics and pandemics as one of 10 key challenges to state security. the world’s worst ebola outbreak in 2014 destabilised entire regions across west africa. health, then, is not only about the individ- ual, and it is more than merely the absence of disease. alongside peace, good governance, respect for human rights, natural resource conservation and the fight against extreme poverty, a well-functioning health system is a bedrock for a life in security and dignity. under the auspices of the german g20 presidency, due to commence on 1 decem- ber 2016, health will be one of the main topics on the agenda at the july 2017 sum- mit in hamburg. at their meeting in heili- gendamm back in 2007, the g8 countries launched a 45 billion euro programme to combat aids, malaria and tuberculosis. at living in security and dignity sabine tonscheidt, director of corporate communications email@example.com elmau in 2015, the g7 countries pledged to boost research in neglected tropical diseases and also increased the funding for the gavi global vaccine alliance. by focusing on health in this issue of akzente, we aim to provide some insights into this complex topic. we hope you will enjoy reading our cover story about business jour- nalist jana schlütter’s visit to south africa, where she discovered how text messaging can improve ante-natal care and how mobile phones can be used in information-sharing for better disease control. health is a vital asset. giz has many years of experience in setting up health insurance schemes in developing countries, includ- ing cambodia, india, indonesia, kenya and rwanda. millions of people for whom health care was unaffordable are now gaining access to doctors and hospitals – and that’s some- thing i think we can justifiably be proud of. best regards, health is not merely the absence of disease. photo: andy kassier (page 2), die hoffotografen/maria vogel (page 3) for a free subscription to akzente magazine, simply send an email to firstname.lastname@example.org, subject: subscribe.
akzente 3/16 4 issue 3/16 the giz magazine health – getting better other topics: opportunities for start-ups in india a new home in afghanistan akzente in brief in the spotlight in focus 16 health: getting better people today are living longer, healthier lives, including in developing countries – but there are still big challenges ahead. 25 ‘we have to reach young people’ interview with latanya mapp frett from planned parenthood global on enabling people to take independent, informed decisions about family planning 26 infographics: more time to live where life expectancy is especially high – and where it isn’t 29 the basis for more prosperous nations margaret chan, director-general of the world health organization, explains the importance of universal health care. 6 updates world conference on urban development, new building for the african union, new commissions in viet nam and zambia background 32 the digital key to the solution apps prevent violence and satellite images help rice producers – lea gimpel, project manager, digital change, reports on new approaches in international cooperation. 3 editorial 30 through the lens 48 info: events and publications 51 sustainability, preview akzente app you can use our app to read akzente on your tablet whenever you want. visit our website for more information on the app as well as current and previous articles from akzente: akzente.giz.de/en. contents 10 two countries, ten entrepreneurs, plenty of ideas boot camp in berlin: indian and german start-up entrepreneurs hone their innovations in the field of renewable energy.
akzente 3/16 5 introducing 50 christiana hageneder towns and cities in ukraine are becoming more energy efficient with her expert support. authors and photographers freelance journalist astrid herbold (1) lives ‘and thrives’ in berlin, in her own words. a seminar there for german and indian start-up entrepreneurs – all thriving on the lively discussions – was the perfect topic for her. photographer thomas grabka (2) accompanied her. jana schlütter (3) is an editor for the science section of ta- gesspiegel newspaper. her article describes global developments in the health sector. in afghanistan, marian brehmer (4), author, and mustafa najafizada (5), photographer, met people who have built new lives for themselves after fleeing their homes. far-reaching change is also part of the lives of the farmers sofia shabafrouz (6) spoke to in malawi. the deutsche gesellschaft für internationale zusammenarbeit (giz) gmbh offers sustainable and effective solutions for political, economic and social change processes. giz is a federal enterprise that employs more than 17,000 staff members and operates in over 130 countries worldwide. www.giz.de/en company profile 1 commitment 34 good neighbours many afghans have fled from their homes to other regions of the country. the town of hamdard shows how their integration can succeed. 40 malawi goes for diversity farmers here have focused on tobacco for years. now, they are breaking out from this dangerous dependency. 44 electricity from the pig farm costa rica is promoting renewable energy, but hydropower alone cannot meet the country’s needs. biogas can help fill the gap. 2 3 4 5 6 photos: thomas grabka (page 4, left), getty images/randy plett (page 4, right), mustafa najafizada (page 5, top), alexey furman (page 5, below) akzente 3/165 234 56
78% of the world’s poorest people depend on farming – because it enables them to feed themselves and their families and because they can generate income from their produce. promoting sustainable agriculture is there- fore a particularly effective way of tackling hunger and creating jobs. 3.2 billion people have access to the internet, three times as many as ten years ago. in developing countries, more people now have mobile phones than have clean water and electricity. nonetheless, almost 60 per cent of the world’s population are still not online and cannot participate in digital develop- ments. 30% of the carbon dioxide produced by humankind since the beginning of the industrial revolu- tion has been absorbed by oceans. underwa- ter algae and bacteria absorb as much car- bon as all plants on land combined. healthy oceans therefore play a vital role in climate change mitigation. in brief akzente 3/16 6 in figures habitat conference cities are centres of progress. they play an important role in realising the united nations’ sus- tainable development goals – including ending pov- erty and combating climate change. this role was reaf- firmed in october 2016 in quito at habitat iii, the un’s third conference on housing and sustainable urban development. prior to this, international rep- resentatives met at the german habitat forum in ber- lin. giz advised the german government on the stra- tegic organisation of the meeting. key messages from the berlin forum were incorporated into the outcome document of the habitat iii conference. www.habitat3.org / www.german-habitat-forum.de/english cities of tomorrow
akzente 3/16 7 massaër gueye a blacksmith from touba in senegal. unable to earn enough in his home country, he has made two unsuccessful attempts to reach europe. a giz project designed to create a market for better, more energy-efficient stoves is now enabling him to generate a good income in senegal. what was your situation before you started producing the new stoves – and how does it compare today? my apprentice and i used to produce 20 traditional stoves a day and sell them on the market, but this wasn’t enough to feed myself and my parents. to- day, i have 15 employees and am able to save a reasonable amount every month. demand for your stoves is high, but they cost around 20 times more than old stoves. why is that? the stoves use much less charcoal and are there- fore a worthwhile investment for buyers. they also last much longer. and you can use them indoors because they produce far less smoke than old- fashioned stoves. how has giz supported you? through training which enabled me to learn how to make the new and improved stoves. because some components are made of ceramic, giz also put me in touch with a pottery cooperative which i now work with. it also provided materials in the begin- ning which allowed me to set up my workshop. g20 leaders’ communiqué, hangzhou summit, september 2016 we will work to ensure that our economic growth benefits all countries and all people. three questions for photo: getty images/johannes mann (page 6), illustrations: getty images/lee woodgate (page 7, left), elliot beaumont (page 7, right) more solar technicians brazil has a large population – around 200 million – and consumes a lot of energy. because it is also very sunny, the country is now taking serious steps to increase its use of solar power. while there were only around 500 buildings equipped with solar collectors in 2015, the na- tional energy agency expects this number to rise to around 700,000 by 2024. however, south america’s largest economy lacks ex- perts to meet this growing demand. giz, on behalf of the german federal ministry for eco- nomic cooperation and development, therefore joined forc- es with several part- ners to open the first school for solar tech- nicians in the capital city brasília in mid- 2016. the electricity generated on the roof of the school is fed directly into the local grid. the first 19 trainees have already completed the 220-hour course on the installation of photovoltaic systems. another 50 trainees will complete the course this year. further training centres are being set up in five other federal states. bright future akzente 3/167
akzente 3/16 8 in brief african union in october, representa- tives of the german government handed over the african union’s newest building in addis ababa. the building, worth an estimated eur 30 million, is a gift from the federal republic of germany. it pro- vides a plenary hall for meetings of the african union’s peace and security coun- cil and situation rooms for the early de- tection of crises and planning of military operations. it also houses the offices and meeting facilities of the peace and securi- ty departments, as well as a library. the photovoltaic system on the atrium roof – in the shape of the african continent – provides clean electricity. the building is made earthquake-proof by flexible materi- als, while water storage tanks keep it cool. the fire water pond includes a stream of flowing water to prevent mosquito colo- nisation. giz planned the work on behalf of the german federal foreign office and was responsible for the technical and fi- nancial supervision of the project. the building was constructed by local compa- nies, whose staff were trained by german tradespeople and short-term experts. www.au.int house of peace source: un-habitat, world cities report 2016 young refugees new opportunities: in august 2016, eight women and men from syria and afghanistan began a preparatory course for training as clerical officers at giz in bonn. the course, which also provides insights into working life, will last one year and is supported by the german federal employment agency. participants are mentored by volunteers from the senior experten service, a private-sector initiative. trainees at giz are also organis- ing activities such as learning groups and a leisure pro- gramme. well prepared in comparison in view of the global trend towards more and more cities with ever increasing populations, urban planning is vitally important. if cities are left to grow haphazardly, this can have negative effects on factors such as the environment, safety and social peace. worldwide, however, the num- ber of city planners varies greatly, as shown by these three examples. planners wanted *city planners per 100,000 inhabitants 1.44 * nigeria 0.23 * india 38 * uk
9 akzente 3/16 bangladesh wiki official language bangla / capital city dhaka / form of government parliamentary democracy / head of state president abdul hamid / head of government prime minister sheikh hasina / size 147,570 km2 / population 161.5 million / population density 1,251 inhabitants per km2  / gross domestic product usd 195.1 billion  / currency bangladeshi taka (bdt) sources:  un data 2016  world bank 2015 new projects higher safety standards in textile factories initial support kosovo people from kosovo whose asylum application in germany has been rejected often find it difficult to return to their home country. to help them find their feet, they are being given support in finding accom- modation, and can apply for a subsidy to- wards the cost of rent and tutoring for their children. job placement services and voca- tional training opportunities are available to help them find new jobs. they are also being offered psychological counselling. these services are coordinated by giz on behalf of the german federal office for mi- gration and refugees. good care viet nam/germany many young people in viet nam are unable to find work, while in germany nurses and geriatric care assistants are required. this project stands to benefit both countries: on behalf of the german fed- eral ministry for economic affairs and en- ergy, giz plans to provide nursing training for up to 200 people from viet nam by 2019. at the goethe-institut in hanoi, participants will complete a 13-month language course, an intercultural programme and training to pre- pare them for their new profession in ger- many. once they have passed these tests, they can begin their training in germany. better conditions textile factories in asia produce clothing for the international mar- ket. however, this is hard and often dangerous work. the collapse of the rana plaza textile factory in bangladesh in 2013 showed the world just how important it is to im- prove safety in the workplace. with this in mind, the lidl supermarket chain asked giz to advise textile factories in bangladesh about safety in the workplace, social and environmental standards, handling chemicals and product quality. modified production work flows and better staff training are also expected to give rise to increased productivity. the project will reach around 30,000 people. in addition to its work in bangladesh, giz is also active on behalf of lidl in côte d’ivoire and china. experienced observers zambia zambia’s presidential elections in august saw edgar lungu re-elected president. at the request of the european union (eu), giz provided support for in- ternational observers of the presidential elections and parliamentary elections which were held at the same time. it or- ganised visas, offices and vehicles, thus ensuring that the observers were able to work professionally. the same applies to follow-up activities after the elections. giz has extensive experience in this field: since 2008 it has supported 19 election observation missions on behalf of the eu. photos: stephanie füssenich (page 9, left), getty images/dave long (page 9, middle), getty images/afp (page 9, right)
two countries, ten entrepreneurs, plenty of ideas at a boot camp in berlin, german and indian start-up entrepreneurs have the opportunity to learn both from and with each other – and to take their innovative ideas in the field of renewable energy a crucial step forward. text astrid herbold photos thomas grabka
11 akzente 3/16 in the spotlight the marshmallows are ripe and need to be harvested now. the playmobil farmer arrives in his matchbox car and plucks them from the fields of yellow paper. he then transports them to the market, where lots of monopoly money awaits him. but what to do with the marshmallow fruits he cannot sell at the market? fortunately, there is a cold storage facility made of light blue card- board nearby which still has spare capacity. the scene unfolding in this courtyard building in berlin-kreuzberg is somewhat unexpected. ten adults sit around brightly coloured mats, wielding scissors and glue, and pushing around little sticks and figu- rines. what may look like an art lesson for nine-year-olds is, in fact, part of a seminar in which five young indian and five young ger- man entrepreneurs are putting their heads to- gether to fine-tune their business models. us- ing a procedure known as ‘rapid prototyp- ing’, they are hoping to gain new insights in- to markets and customers. ‘we are trying to see things from the perspective of an indian farmer,’ says arno zimmermann. ‘can he afford to spend mon- ey on a cold storage facility for his produce? if so, under what circumstances would he do that?’ zimmermann has a keen interest in this. the 29-year-old recently founded the company coolar with a team of engineers in berlin. the start-up is developing an environ- mentally friendly refrigerator which can op- erate without a diesel motor, photovoltaic system or battery. the trick is that the heat of the sun is stored in water tanks and converted to cooling energy through the physical pro- cess of adsorption. the refrigerator will be used, among other things, to store vaccines in africa. ‘we are considering whether indian farmers could also be a market for us,’ ex- plains christoph göller, who also works for coolar. » " we are consider- ing whether indian farmers could also be a market for us. " making the right strategic decisions at the right time is a challenge for many start-ups. that is why competent business partners are so important. in both germany and india, there are flourishing communities of entre- preneurs in search of innovative solutions in the field of renewable energy. however, there is very little constructive contact. moreover, in india there is little dialogue between large corporations and entrepreneurs. there are around 160 incubators and accelerators throughout the country that promote start- ups, but these are often still relatively new themselves with little in the way of contacts. as a result, indian entrepreneurs rarely come into contact with investors and influential company representatives even within these hubs. on behalf of the german federal min- istry for economic cooperation and devel- opment, giz has therefore been actively promoting closer cooperation between start- ups, incubators and companies in india since 2015. this strategic alliance is part of the developpp.de programme, which fosters private sector engagement for sustainable development. its cooperation partners are bosch engineering and business solutions – an indian subsidiary of the german technol- ogy group – and the indian company intel- lecap, which promotes social enterprises in remote regions. wanted: innovative methods of supplying energy the aim of the alliance is to establish a vari- ety of networks between incubators, start- ups and large corporations by 2017. for- mats such as boot camps and demo days, which bring together start-ups and compa- nies, are currently being tested. the startup- wave platform has also been expanded and now offers opportunities for cooperation
12 akzente 3/16 left: question and answer session: arno zimmermann (above) and a team of entrepreneurs have developed an eco-friendly refrigerator. together with other entrepreneurs, seminar partici- pants discuss how they can improve their companies (below). right: work and play: strengthening team spirit (below), before the model- building begins (above).
13 akzente 3/16 in the spotlight creativity and teamwork: engineer piyush sohani fine-tunes his business model for a biogas system at the boot camp. also available on the akzente app and on the website: entrepreneur lara obst reports on her start-up mowea. akzente.giz.de/en » between corporations and start-ups. ‘we consider ourselves to be bridge-builders,’ says project manager eileen trenkmann. ‘we want to lend start-ups a helping hand at an early stage and establish ties with strong partners.’ another project is already success- fully under way: together with the social en- terprise aravind, which provides free eye ex- aminations and operations for poor people living in rural areas of india, bosch and giz have successfully introduced technical inno- vations in eye clinics. in berlin, too, the focus is on bringing together what belongs together. the partici- pants all have one thing in common: they have been thinking about energy for many years – whether in the form of alternative sources, cooking with renewable energy or energy-efficient cooling. these are pressing issues in india, where at least one fifth of the population lives below the poverty line. storing food is particularly problematic in rural areas. as a result, more than one quar- ter of agricultural produce is lost on the way to the consumer – because there is no relia- ble electricity supply, because of a lack of storage facilities or because the cold chain is interrupted during transportation. in addi- " we want to lend start-ups a helping hand at an early stage and establish ties with strong partners. " tion, 85 per cent of people in rural areas still prepare their meals on wood fires. gas stoves would be healthier and more envi- ronmentally friendly, but gas is unafforda- ble for millions of indians. entrepreneurs meet partners who can open doors for them twenty-eight-year-old engineer piyush soha- ni knows that most people still use primitive cooking stoves even in villages just outside delhi. although small biogas systems that can be filled with organic waste by farmers are installed next to residential buildings, hardly anyone uses them. ‘the systems are outdated and unreliable,’ says sohani. this is why he set up the company sustainearth en- ergy solutions at the university of delhi in 2013 to produce biogas systems. the proto- type is now complete and is currently being tested. from more than 100 applicants, a panel of judges selected 10 people to take part in the boot camp. the strong thematic focus makes it easy to find topics for conversation – even if, a little shy, the indian and german entrepreneurs choose to sit separately on
14 akzente 3/16 top: creative tools: what may look like a children’s handicraft lesson is also a good way to illustrate concepts. bottom: ideas at work: together boot camp participants test how their products would work in practice.
15 akzente 3/16 in the spotlight strategic partners bosch, intellecap and giz, on behalf of the german federal ministry for economic cooperation and development, are working together to promote cooperation between large corporations, incubators and innovative start-ups. they are improving the oppor- tunities for incubators through coopera tion with corporations. they are also providing direct support for ambitious entrepreneurs with promising ideas through events such as the 10-day boot camp in berlin for selected start-ups from germany and india. putting ideas into action at a glance from india include entrepreneurs who offer diesel-free cooling systems for lorries and software for solar installations, while german participants include companies looking to sell mini wind turbines and biogas stoves. ‘informal exchange is particularly im- portant,’ says mareike müller from the social impact lab, which organised the seminar in conjunction with giz. the social impact lab specialises in promoting social enterpris- es and offers mentoring programmes in sev- eral german cities. ‘the intensive workshops will give the entrepreneurs plenty of food for thought to take home with them. plus, they are getting to know people who can open doors for them at a later stage.’ grand finale: the pitch and the next steps the entrepreneurs are especially keen to hear from cooperation partner bosch. the com- pany takes its role as a mentor seriously: manohar esarapu and a colleague attend ev ery seminar, and provide detailed feedback in group discussions and on a one-to-one basis. in the case of piyush sohani’s biogas system, it quickly becomes clear that there are still some unresolved issues with regard to the business model. the entrepreneur has been considering a solution which would even al- low farmers to earn money from the system – by selling the fertiliser that is a by-product of gas production. the only problem is: who would collect, transport, package and sell it? sohani has to face a number of difficult ques- tions. nonetheless, he is grateful: ‘i now know what i need to work on.’ the crucial test comes on the last day in the form of the pitch, where start-ups present their ideas to investors. more than 30 people gather to hear what the entrepreneurs have to say, including representatives from the energy companies vattenfall and rwe. the rules are strict: the entrepreneurs were able to practise their presentations the day before with a trainer from silicon valley. they have just five minutes to spark the interest of the audi- ence. a stopwatch relentlessly counts down the seconds. in the end, coolar wins the title of best ger- man start-up and goes home with an invita- tion to india. sohani is also very pleased: ‘i’ve made a lot of progress.’ his business model has come along so far that he can sum it up in just a few words. he is now hoping to take it forward to the next stage and plans to repeat his presentation in the near future, this time in india, in front of indian corporations and investors. > contact eileen trenkmann > email@example.com the first day. one group is dressed formally in suits and shirts, while the other is wearing the jeans and trainers typical of berlin. however, it is not long before the ice is broken. by the third day, the atmosphere is much more re- laxed during the model-building exercise. ‘it’s great that we can chat on equal terms here,’ says arno zimmermann from coolar. there are plenty of connecting factors: participants
getting better: nowadays, people are living longer, including in the developing countries – but in many places health systems are still far from robust. overview: examples of giz’s work in the health sector ‘we have to reach young people’: interview with latanya mapp frett from planned parenthood global infographics: more time to live – especially for women the basis for more prosperous nations: guest article by who director-general margaret chan health themes
akzente 3/16 19 in focus it’s a different story. the problem is particularly acute in provinces like kwazulu-natal, where 40 per cent of the population and 25 per cent of women under 21 are living with hiv. it is vital to protect the health of their unborn babies, so pregnant women with hiv need to be identified, given medication and monitored continuously. however, some of the mothers-to-be are teenagers or survivors of violence. some prefer not to be tested for hiv, so they don’t turn up for ante-natal appointments. and in some cases, the health centre is too far away. this is where momconnect comes in: it leverages the use of mobile phones – now available even to most people living in poverty – to empower women. any woman who thinks she might be pregnant can register with momconnect right away. the first few text mes- sages encourage her to attend an ante-natal appointment and register for care. electronic patient records are set up for her and can be updated by any clinic, midwife or health worker in her district. the information is also en- tered into the national pregnancy database. with the electronic medical record system, the women then receive automatic alerts and tailored mes- without sms, i would have forgotten about this appointment,’ says neliswa, folding her hands over her baby bump. the young woman from south af- rica is 22 weeks pregnant. she has no partner – and no support from her family. even so, she is looking forward to having the baby. ‘but i don’t know much about preg- nancy,’ she admits. her midwife advised neliswa to register with mom- connect. since signing up, she has received regular text messages on her phone, reminding her about those all- important check-ups, telling her which signs of possible complications to watch out for, and giving her tips on healthy eating. there’s a help desk to answer her ques- tions as well. ‘i feel less isolated now,’ she says. on the face of it, south african health care is in good shape. people with private health insurance can ac- cess quality care in state-of-the-art hospitals whenever they need it. but when it comes to free basic health care, getting better nowadays, people are living longer and staying healthier, including in the developing countries – even though health systems there are often still far from robust. major progress has been made in the fight against child mortality and diseases such as aids and polio. text jana schlütter knowledge and confidence: in some african countries, doctors are now better trained. nevertheless, there is often insufficient basic medical care. » photos: afp/getty images/jean-philippe ksiazek (page 16/17), getty images/the image bank/randy plett (page 18) akzente 3/1619
in focus akzente 3/16 21 sages appropriate to their stage of pregnancy. after the babies are born, new mothers continue to get text mes- sages for up to a year. ‘if neliswa misses an appointment, the system will flag it up,’ says her midwife lerato molefe. ‘and then we send someone along to check on her.’ a review of the momconnect pilot project in kwa- zulu-natal showed that the text messages have helped to reduce mother-to-child transmission of hiv from more than 20 per cent to roughly 2 per cent and that baby care skills have greatly improved. momconnect, which is sup- ported by various international donors, is now one of the south african health ministry’s flagship projects. the free service targets all expectant mothers across the coun- try and has empowered 900,000 users to access health care. adequate treatment not yet the norm substantially reducing child and maternal mortality worldwide is one of the international community’s major goals. by 2030, it aims to cut maternal mortality to less than 70 per 100,000 live births and child mortality to no more than 25 per 1,000 live births. these targets form part of the sustainable development goals (sdgs) adopted by the united nations in the 2030 agenda for sustainable development in 2015. but for many of the world’s countries, these goals are hard to reach – and south africa is one of them. nonetheless, remarkable progress in improving health has already been achieved with the millennium develop- ment goals, including a sharp reduction in child mortality to 43 per 1,000 births today. these improvements have saved the lives of 48 million children, as a team of united nations and world bank researchers led by danzhen you report in the medical journal the lancet. even low-in- come countries such as bangladesh, ethiopia and cambo- dia have made progress despite very challenging starting conditions. what’s more, between 2000 and 2015, malaria mortality rates fell by 60 per cent globally and the number of new cases decreased by 37 per cent. the number of aids-related deaths has fallen by 41 per cent, and new in- fections have decreased globally from 3.1 million to two million a year. as these figures show, real progress has been achieved. even so, access to appropriate care is still not the norm. in the developed countries, it is sometimes a lack of in- surance coverage which puts health care out of reach. some life-saving cancer drugs are now so expensive that even high-income countries are reaching their limits – at a time when cancer seems set to overtake heart disease as the number one killer. in the low-income countries, in- fectious diseases are still the leading cause of death, but here too, diseases of civilisation, such as diabetes and car- diovascular disease, which are associated with rising liv- ing standards, are now on the increase as well. many countries and regions are a long way from achieving the type of comprehensive health care envis- aged in the sdgs. the gap is widest in west africa. the world health organization (who) recommends a minimum threshold of 23 doctors, nurses and midwives per 10,000 population – but before the ebola epidemic, the figures for liberia, sierra leone and guinea were just 0.1, 0.2 and 1.0, respectively. lack of access to electricity and clean water is a problem everywhere: even hospitals rarely have a reliable supply. disease surveillance is also very limited in many de- veloping countries. after the severe acute respiratory syndrome (sars) outbreak caused panic around the world, who members agreed that every country should implement more stringent infection control and establish an appropriate basic infrastructure. outbreaks posing a risk to human health should henceforth be reported to who in geneva within 24 hours. however, two thirds of the who member states have still not met the stand- ards set out in the international health regulations. so no one noticed when, in 2013, a two-year-old boy suddenly fell ill with diarrhoea that was black with blood and died soon afterwards. emile and some of the other children from meliandou, a remote village in south-east guinea, had climbed into a hollow tree to catch bats. one of the animals is thought to have been in- fected with the thread-like ebola virus. emile was ex- ‘he who has health, has hope; and he who has hope, has everything.’ proverb photo: getty images/photononstop rm/pascal deloche/godong (page 20) improvisation works: a wooden pole, with a few nails hammered in, makes a good iv stand. years is the longest human lifespan on record, achieved by frenchwoman jeanne calment (1875–1997). 122 » akzente 3/1621
130,000,000 12% 99% 2,500,000 akzente 3/16 22 in focus w ith a big smile, hom nath dhakal holds up a plastic card – proof that he now has health insurance. until now, any medical treatment other than basic health care had to be paid for out of his own pocket – and if he couldn’t afford it, he managed without. but not any more: hom nath dhakal is the first citizen of nepal to use the social health protection phased in by the government since april 2016. getting to this stage took a lot of preparation – from building political ac- ceptance to establishing technical struc- tures. on behalf of the german govern- ment, giz has been actively involved in this process for many years, providing the government of nepal with support and advice on setting up the health insurance scheme. and nepal is not the only coun- try to close an insurance gap for its citi- zens with german support. giz has played its part in establishing similar schemes in india, indonesia, rwanda and kenya. health insurance for low-income groups is a key focus of giz’s work in the health sector. other priorities include in- fectious disease control; prevention of pan- demics; promoting sexual and reproductive health, including maternal health and safer childbirth; reducing child mortali- ty; optimising information systems and data management; strengthening health systems; and providing training for health workers. drawing on decades of experience, giz is currently implementing health pro- jects in more than 80 countries in africa, asia, latin america and, increasingly, europe. on such a sensitive topic as so- cial justice – which ultimately encom- passes health as well – giz makes it a priority to pursue a culturally appropriate approach, take account of diverse gender needs and minimise exclusion. its guiding principle is ‘leave no one behind’ – the watchword of the 2030 agenda for sustainable development. women and girls, low-income and other marginalised groups are a particu- lar focus of giz’s work, the aim being to ensure that quality health care is acces- sible to everyone. this has not yet been achieved everywhere. nonetheless, consid- erable progress has been made in health care over the past two or three decades – in nepal and many other countries around the world. people have joined india’s national health insurance programme (rsby) in just six years, making it one of the world’s largest schemes. the membership card provides access to hospitals across india. health insurance in india examples of giz’s work health is one of the core compe- tences of giz, which can draw on a wealth of experience spanning decades. low-income and marginalised groups are the priority. awareness-raising in tanzania is the teen pregnancy rate in some of tanzania’s schools. thanks to an education programme supported by the german government, the rate has fallen dramatically – from 41%. workplace health in bangladesh fewer accidents and injuries have occurred among the 3,500 employees at western marine shipyard ltd. in bangladesh since a new workplace health and safety system was introduced with the support of the german federal ministry for economic cooperation and development (bmz). primary school children in the philippines have taken part in the fit for school programme. they now have access to improved nutrition and are less likely to suffer from worm disorders and dental caries. nutrition in the philippines
akzente 3/16 23 » them to the central database by mobile phone. the pa- tient is immediately sent to an isolation unit. in the case of the radiologist, a total of 197 contacts were identified by the mobile team and monitored for three weeks. all tested negative for marburg and were given the all-clear. it was a very different scenario in meliandou: emile’s death sparked a chain of events with tragic consequences. according to who statistics, a total of 28,646 ebola cases were reported in guinea, liberia and sierra leone, with at least 11,323 deaths. in mid-2014, the health sys- tems in these three countries at the epicentre of the out- break came close to collapsing under the weight of ebola. malaria patients were no longer treated nor children im- munised, and mothers-to-be no longer had access to ante-natal care. but lessons were learned from ebola, as the recom- mendations published by four international commissions showed. ‘infectious disease pandemics represent one of the potent threats to humankind, both in terms of po tential lives lost and in terms of potential economic dis- ruption,’ according to the commission on a global health risk framework for the future, chaired by pe- high tech for better health care: rwanda is trialling drones to deliver medicines to remote areas. tremely unlucky, but the chain of events sparked by his illness in 2014, plunging three countries – guinea, sierra leone and liberia – into crisis and reversing these coun- tries’ development progress, could have been prevented. a similar situation might have arisen in uganda in 2014, when a young male radiologist came down with di- arrhoea and began vomiting blood. his doctors near kampala transferred him to one of the major hospitals. he died, but the marburg virus which killed him, al- though similar to ebola, was successfully contained and while his death was a tragedy, it remained an isolated case. so how did uganda come through the outbreak rela- tively unscathed? it was all down to effective prevention. after suffering a particularly severe ebola epidemic in 2000, uganda – with the international community’s sup- port – set up a mobile technology-based monitoring sys- tem. the uganda virus research institute (uvri) also underwent a programme of capacity building, and a viral special pathogens laboratory was established. trained health workers are now able to identify suspected cases of ebola or marburg, even in remote villages, and report photo: afp/getty images/cyril ndegeya (page 23) akzente 3/1623
akzente 3/16 24 in focus babies at once: the largest number of live babies ever delivered in a single birth 8 » ter sands from harvard university. and yet this dimen- sion of global security is often neglected. implementing the commission’s recommendations on pandemic pre- vention would cost around 4.5 billion us dollars per year. of this total, about 3.4 billion dollars relate to the costs of upgrading public health and early warning sys- tems, and the international community needs to invest a further one billion dollars in research and development of diagnostics, therapeutics, vaccines and other equipment. however, the main responsibility, according to the com- mission, lies with national governments. the who, it says, should define minimum standards against which countries should identify their weaknesses and determine ways of addressing them. every outbreak a risk to the world’s people ‘resilient health systems are the first line of defence,’ says who director-general margaret chan, for diseases not only have the potential to adversely affect economic de- velopment but can also cross borders unhindered. ‘in a profoundly interconnected world, there is no such thing as a local outbreak.’ judith rodin, president of the rock- efeller foundation, which has made health one of its core issue areas, agrees. ‘if all we did was to build health cen- tres, we would have failed,’ she says. every small hospital must be integrated into a cohesive network that extends from remote villages to the capital cities. initial efforts to share information and knowledge more efficiently are already under way. basic mobile phones are all that’s needed. in liberia, for example, mhero – a two-way, mobile phone-based communica- tion system that uses basic text messaging, or sms – con- nects the ministry of health and local health workers. during a crisis or emergency response, messages are tar- geted to health workers based on unit, location, or skill set. the health workers, in turn, collect and pass on criti- cal information about supplies and staffing levels, hospital closures or the progression of a disease in their locality. guinea, sierra leone, senegal and mali are also trialling the system. digitalisation: creating new opportunities when a dengue fever epidemic struck punjab in pakistan in the summer of 2011, the province did not yet have a properly functioning disease control system. faced with very large numbers of patients, the hospitals in cities such as lahore struggled to cope. so the punjab information technology board (pitb) set up a free telephone help line, staffed by operators with medical training. they took hundreds of thousands of calls from the public and provided an emergency triage service: callers would de- scribe their symptoms and were then referred to hospitals which still had empty beds. a statistical software pro- gramme kept a tally of calls, analysed weather conditions and other variables and projected the likely progression of the epidemic, so that health workers knew precisely where to target mosquito control measures or alert hospi- tals in preparation for large numbers of patient admis- sions. the incidence of the disease decreased noticeably in subsequent years. mongolia, too, is utilising the opportunities afforded by digitalisation in the health sector. here, as in various other countries, telemedicine is supporting the surveil- lance of high-risk pregnancies in remote areas. rural health centres are connected to specialists in the cities via the internet. this facilitates joint decision-making on the level of risk to mother and baby and on whether a patient needs to be moved to a city hospital for treatment. infection control – along with information-sharing – also has an important role to play in preventing in-hos pital transmission of diseases. stringent compliance with hygiene regulations is essential, there must be adequate stocks of protective clothing and disinfectant available, and staff must act quickly to isolate patients who are con- tagious. even well-resourced health systems do not al- ways cope with these challenges, as the spread of mers- cov, a virus which causes severe respiratory disease, in south korea shows. the first case – in a returning travel- ler – sparked a chain of in-hospital infections, with an- other 186 people in south korea subsequently contract- ing the disease. the worldwide problem of multidrug re- sistance in bacteria is another example. ‘what we have here is a society living in luxury yet rife with malnutrition.’ sarah wiener, austrian tv chef
akzente 3/16 25 it is agreed by the international community that every woman and man should have access to reproductive health services and modern contraception. yet, we have not accomplished that goal – why? indeed, hundreds of millions of people still do not have that access, even though they wish to use contraception. why? in the end it goes back to a lack of leadership and commitment. reproductive health is mainly a women’s issue. and women tend to get relegated to the bottom of the pile. so although we have seen a lot of progress over the past two decades particularly around contraception it is still a question of gender equity and marginalisation. it’s the poor women that are hardest hit. it’s not a matter of logistics? if you had asked me that question ten years ago i would have answered it differently. but today we know how to reach everyone. and we could reach everyone if the priorities were set right and if we had the necessary resources – in the countries themselves and within the donor community where we sense a slight downgrading of the topic within the eu, for example. where do we fall particularly short in the world? the need is greater in the developing countries of africa and asia, especially in sub-saharan africa and parts of south-east asia. we also still see cultural barriers that we have to break through. women around the world for the most part have already broken those barriers; it’s the families, the communities and governments that sometimes lag behind, although in general, as i want to emphasise, we have made great progress in the past years. in indonesia, for example, over half of all women of reproductive age are now using contraception and the trend is upwards. are you saying that women around the world do want to practice birth control regardless of their cultural background? absolutely – women everywhere want to use modern contraceptives. they want to take that decision because they know the influence the issue has over their lives. in which segment of the population do you see the largest gap? i see the biggest need among adolescents; they often do not have adequate access to contraceptives. yet, this is when people start thinking about sexuality. if we do not reach them early enough young women are pregnant before they were able to grow up, finish school and learn. plus, very early pregnancy is particularly dangerous. so, we need better access to information and health services for young women. what should be done to better reach that age group? several elements need to be in place to better reach young people: political will, open societies and the necessary medical supplies and services corresponding to their behaviour and needs. we have to use more innovative ways to get the message across, e.g. all the social media channels. what are some of the major consequences of that deficit? first of all, not meeting female needs means denying people the basic right of choosing how many children they want to have. second, it puts them at great risk: in many countries pregnancies are still very hazardous due to the lack of medical support. mothers die and infants die for reasons that shouldn’t be possible in the twenty-first century. can digitalisation make a difference in this endeavour? yes, in that we can reach more people with all kinds of new technologies. planned parenthood global recently launched a programme with the united nations population fund (unfpa) called global mobile which is doing exactly that: increasing access to information, particu- larly among adolescents, by meeting them where they live online. but we all have to continue developing such digital offers because they are a great opportunity towards the larger goal. how much longer will it take until everybody really has access to birth control? i think we can achieve the goal by 2030, as laid out in the 2030 agenda for sustainable development. interview: friederike bauer ‘we have to reach young people’ latanya mapp frett is the executive director of planned parenthood global, an ngo that is working to expand family planning programmes across africa and latin america. she sees a particular need for birth control among young people. latanya mapp frett is an american with a background in international affairs and development issues, starting her career at the united nations. photo: john mims (page 25) akzente 3/1625
68.8 66.1 64 60.5 71.5 1974 1984 1994 2004 2014 an upward trajectory as a global average, today’s generations are likely to live significantly longer than their parents and grandparents – thanks to better health care. a long and healthy life – or a life cut short? with comprehensive health care, life expectancy in japan is the highest in the world – 30 years longer than in sierra leone. japan – 83.7 years switzerland – 83.4 years singapore – 83.1 years australia – 82.8 years spain – 82.8 years lowest life expectancy côte d’ivoire – 53.3 years chad – 53.1 years central african republic – 52.5 years angola – 52.4 years sierra leone – 50.1 years highest life expectancy high and low expenditure total global spending for health per person per year averages 948 us dollars, ranging from 8,362 dollars in the us to just 12 dollars in eritrea. more or less support almost three quarters of all births are attended by a skilled health worker. in botswana, the figure is 100 per cent, compared with only 9 per cent in somalia. 54 16 africa europe high rates, low rates despite major advances in medical care, women are still dying in childbirth – even in europe, where 16 women die for every 100,000 live births. the little difference women live longer than men. based on global averages, they have a life expectancy of around 73 years, up from 65 years in 1981. men can expect to live for 69 years, compared with 61 in 1981. nowadays, people are living longer – and this trend can be observed all over the world. but there is still a major life expectancy gap between the developed and developing countries. europeans can expect to live to around 80 years of age, but africans are likely to die two decades earlier, at just over 60. more time to live 19741984199420042014 5416
27 in focus devastating multidrug-resistant pathogens are particu- larly prevalent in india. infections are especially common in newborns – the most vulnerable group. due to the fre- quent lack of toilet facilities and sanitation, harmful pathogens enter drinking water and contaminate foods, and many women give birth in unhygienic surroundings. even untrained auxiliary midwives therefore administer broad-spectrum antibiotics as a precaution. however, this form of prevention has extremely adverse conse- quences. multidrug-resistant bacteria which, in the past, were almost unknown outside hospital settings are now commonplace across india, and newborns are exposed to these pathogens, mainly through contact with their mothers. every year, the resulting antibiotic-resistant in- fections kill some 60,000 newborns in india alone. in order to mitigate these risks and make more effec- tive use of the available expertise, governments need to create stronger linkage between vertical, i.e. stand-alone, health programmes, which focus on specific diseases, such as malaria, or immunisation campaigns, and hori- zontal programmes, which aim to improve general ser- vices within health systems. this is feasible even under difficult circumstances, as the example of rwanda shows. after the genocide in 1994, the country and its health system lay in ruins. recovery was heavily depend- ent on external support, such as the advisory services pro- vided by giz. today, 94 per cent of rwandans have health insurance – more than any other african country. rural health workers are able to make their own assess- ment of patients with the most common ailments and re- fer more serious cases to hospital, where patients pay just 10 per cent of the costs. for patients on very low in- comes, children without parents or persons living with hiv, the costs are covered by international donors. two decades after the genocide, child and maternal mortality has decreased by two thirds and the number of deaths from aids and tuberculosis is falling more rapidly than elsewhere. life expectancy has risen from 42 to 67 years. sometimes, however, cultural and religious obstacles stand in the way of progress. in 2003, the goal of eradi- cating polio in nigeria was within reach. then without warning, the political and religious leaders in three north- ern nigerian states brought matters to a halt by encour- aging parents to boycott the immunisation campaign. their arguments sounded far-fetched: they claimed that the vaccine could cause sterility in girls or infect people with aids or cancer. it was all part of a western conspir- acy against muslims, they claimed, and they had evidence to prove it. ‘they presented us with thick files packed with articles downloaded from the internet,’ says » ‘good maternal nutrition – the best start in life’: advice from the world health organization (who) fewer smokers in some regions of the world, people are less likely to reach for a cigarette nowadays. in the us, smoking rates have halved since 1980. less polio thanks to intensive immunisation campaigns, the world is close to eradicating polio. it is now endemic in just three countries: afghani- stan, pakistan and nigeria. less hiv/aids the number of new hiv infections has fallen dramatically from 3.2 million in 2000 to 2.1 million in 2015. 2000 2015 3.2 million 2.1 million fewer child deaths child mortality is on the decline. the number of deaths worldwide fell by almost half between 1990 and 2015. sources: eurostat, ‘the tobacco atlas’, unaids, unicef, world bank, who 20002015
akzente 3/16 28 anti-malaria: this mosquito collection in mozambique helps to improve knowledge of vector-borne diseases. mpedigree, a start-up from ghana, has developed a system to enable patients to check the authentic- ity of drugs. the patients send a code, found on the packaging, by sms. a few seconds later, they get a text back confirming the status of the drugs. http://mpedigree.net www.giz.de/health heidi larson, an anthropologist at the london school of hygiene and tropical medicine. it took 11 months for the leaders in the three regions to be convinced otherwise. a muslim manufacturer of the vaccine was found and samples were sent for inde- pendent testing in muslim countries. various confer- ences were organised. the rumours have now died down. as a result of the conflicts with terror group boko haram, however, nigeria is still one of three countries in the world with endemic polio. time and again, experience shows how important it is to listen to people and to try to understand the reasons be- hind their behaviour, for without public support, disease control is impossible. doctors ranu dhillon and daniel kelly still recall the case of six-year-old fatou from guinea. the little girl had a very high temperature and was vomit- ing – worrying symptoms, for fatou, like the rest of her family, had been exposed to ebola at the funeral of her un- cle, who had died of the disease. a response team was dis- patched to bring her to the ebola treatment centre for test- ing, but her grandmother vehemently refused. ‘you are go- ing to cut her into pieces!’ she screamed. ‘help me! they are trying to kill my grandbaby!’ as the doctors explain in the new england journal of medicine, the grandmother was not being uncoopera- tive because she was backward or uneducated. rather, her reaction reflected guinea’s complex historical circum- stances. after 25 years of dictatorship, guinea was taken over by a military junta. understandably, this has fuelled a well-founded distrust of formal power structures, with people relying instead on their traditions, communities and family ties. the grandmother did not relent until the following day, when the response team came back, this time accom- panied by gendarmes. and she was reassured when she saw that the team was treating her granddaughter with kindness. fatou was taken to the treatment centre and was soon discharged – thankfully, she was ebola-free.
akzente 3/16 29 in focus the basis for more prosperous nations guest article by director-general margaret chan profile margaret chan was appointed director-gener- al of the world health organization (who) in 2006. born in hong kong, her particular interest lies in building strong health systems. s ince the start of this century, the world has witnessed dramatic demo- graphic and economic changes. rapid and unplanned urbanisation and rising in- come levels in many countries have had profound knock-on effects in terms of diet and lifestyle for hundreds of millions of people. those changes have significant implica- tions for the health of populations and the challenges that health systems are facing. rising income levels have given people greater access to health services, but con- versely have led to more sedentary lifestyles and increased consumption of unhealthy products. people are living longer, but not necessarily healthier lives. as a result, non- communicable illnesses like heart disease, cancer and diabetes have overtaken infec- tious diseases as the biggest killers world- wide. these shifting lifestyles and behaviours place new demands on health systems, many of which have historically been built to manage the burden of communicable dis- eases. it is clear that health systems must evolve to respond to disease patterns and to cope with the ever-increasing costs of pro- viding care for people living longer, sicker lives. at the same time infectious diseases con- tinue to be a challenge for health systems: the ebola outbreak demonstrated all too tragically that weak health systems don’t just expose one country’s population to danger; they are a threat to global health security. last year’s g7 summit in germany empha- sised that well-functioning health systems are the first line of defence against emerging and re-emerging infectious diseases, and a bulwark against health threats of all kinds, whether they be outbreaks, natural disasters or conflicts. the inclusion of universal health cover- age (uhc) as one of the 169 targets adopted by world leaders last year as part of the sus- tainable development goals was a signifi- cant acknowledgment that the health chal- lenges of the twenty-first century cannot be addressed by programmes that focus on sin- gle diseases. among the health-related tar- gets, uhc is the one that, if achieved, will help deliver the other targets through health systems based on strong primary care that make people, not diseases, the focus of care, and which offer services that are free of user charges at the point of delivery. but uhc will not be achieved with a snap of the fingers. among other challenges, building the health systems of the future will require a transformation of the global health workforce. governments can no longer see their health workers as a cost to be managed, but as an investment that will pay rich dividends not only for health, but also for employment, economic growth, se- curity and the empowerment of women, who in some countries make up 75 per cent of the health workforce. strong health systems that deliver uni- versal health coverage aren’t a luxury for rich countries; they are the bedrock of fairer, safer and more prosperous nations. but health systems cannot be expected to solve modern health challenges in isolation. safe- guarding the health of populations will re- quire an approach across the whole govern- ment that creates healthy environments, promotes social determinants of health and addresses the root causes of chronic disease. after all, prevention isn’t just better than a cure, it’s cheaper. photos: getty images/axiom rm/chris martin (page 28, top), picture alliance/chromorange (page 28), illustration: elliot beaumont (page 29) akzente 3/1629
through the lens
a carefree moment: during dashain, a hindu festival in nepal, it is the custom to take at least one ride on a traditional swing. known as ‘pings’, the swings are constructed especially for the festival and are intended to drive out negative emotions and painful memories – such as recollections of the earthquake in april 2015 which killed thousands of people and left many more homeless. on behalf of the german federal ministry for economic cooperation and development (bmz), giz is supporting reconstruction in nepal. photo: navesh chitrakar flying high
akzente 3/16 32 background apps that help prevent violence and satellite images that support rice production – lea gimpel explains how innovative technologies and approaches are influencing international cooperation. the digital key to the solution d igitalisation is changing the world – and the face of international coopera- tion. at giz, we have been making use of digital elements in our projects for a very long time: for example, an education pro- gramme can often reach more people via an online platform than through conventional channels. what is new is that digital applica- tions are, more and more often, the key to the solution, not simply an add-on. take ecuador: here, we offer an app to prevent violence against women, which is a widespread problem across the country. the world health organization (who) esti- mates that around half of the women in ec- uador are at risk from violence at the hands of their partners. the app has an emergency function, so women can call for help at the touch of a button – without their attacker noticing. the advantage is that the app is pre- installed on all mobile phones supplied un- der contract from the national telecoms pro- vider (cnt), so no one has to explain why they have it on their phone. we were com- missioned by the german federal ministry for economic cooperation and develop- ment (bmz) to develop the app in conjunc- tion with cnt. partners are important to us. they may be major digital industry compa- nies, innovative start-ups or ngos working in the technology sector – we cooperate with them all. apps such as the one in use in ecuador are just one aspect of our work. in many other projects, it’s all about data. in south- east asia, we are using satellite images to monitor rice production in five countries. this enables a faster response if there is a threat of crop losses that would pose a risk to food security. we are also working with part- ners such as allianz to develop crop insur- ance for farmers. with the data, insurers can offer cheaper cover. it’s no longer necessary to travel to the region to evaluate damage – the insurance experts can simply make an assess- digitalisation has many possible applications but it is not a cure-all. making use of digital tools such as apps or data analysis only makes sense if we reach the target group. many peo- ple still have no access to the internet – or the skills to use it. so we are developing e-skills training, especially for women, who are often at risk of becoming disconnected from the digital world. education has always been one of giz’s priorities, and here we are seeing how the more traditional type of develop- ment cooperation and digitalisation can op- erate in tandem. when talking about digitalisation, we have to mention the risks too. data should be managed responsibly. surveillance is another topic of relevance to us, especially in coun- tries with authoritarian regimes. we often operate in countries where data protection is well below german standards, and that can cause problems for us as a federally owned enterprise. in future, we would like to offer targeted advice on data protection in such cases. the digital revolution is about rethink- ing international cooperation. it is not just about the technologies for their own sake: it is about working with partners to identify so- lutions with users in mind. it’s about being flexible and constantly improving the way we work. lea gimpel, project manager, digital change, firstname.lastname@example.org previous ‘background’ articles on giz’s work can be found here: akzente.giz.de/en ment based on the images, substantially re- ducing their costs. there are new opportunities in health care as well. for example, hospital manage- ment projects are looking at ways of collect- ing and evaluating patient data more effi- ciently, not least to combat corruption. what diagnosis was a patient given? which treat- ment regime was prescribed, and which drugs were they given – and what were the charges? illustration: elliot beaumont
good neighbours afghanistan how the country’s internally displaced people are building new livelihoods. page 34 focusing on diversity malawi how the country’s farmers are moving away from a dangerous dependence on tobacco farming. page 40 electricity from the pig farm costa rica how the owners of a pig breeding facility and a football club are generating clean energy. page 44 commitment where giz is active, how it approaches new challenges, what its projects achieve: three examples of giz’s current work in costa rica, malawi and afghanistan.
commitment 35 akzente 3/16 t he bright colours worn by the children stand out like splashes of paint against the mud-coloured houses and the brown folds of the hindu kush mountains. young girls car- ry even younger siblings along the sandy dirt roads. every so often, a shop owner peers out from the shadows of a modest store at the cor- ner of a street. this is hamdard, a settlement on the outskirts of the city of mazar-e sharif in northern afghanistan. in 2012, the village be- came home to more than 1,000 people who fled here from other parts of the country. one person who has started a new life in hamdard and now lives in a mud house with a garden of its own is faiz mohammad. his face furrowed, the 53-year-old family man wears a light-green turban. his skin is deeply tanned by a lifetime of work in the sun. when the taliban invaded mohammad’s vil- lage south of mazar-e sharif in 2012, the family fled to the nearby provincial capital. initially, the new arrivals found shelter in fa- cilities provided for refugees by the inhabit- ants of hamdard. accommodated in a tent beside a sinkhole, the family literally found themselves being left with nothing. four years on, faiz mohammad sits on the carpet of his living room and talks about how hard life was here for him, his wife and their nine children at first. it took some time for anything resembling normality to resume. ‘four of my children now go to school. they love their lessons.’ the other five have already finished school or are working, one of them as a builder of mud houses. mohammad, too, can read and write – by no means something that can be taken for granted in a country with illiteracy rates close to 70 per cent. escape from vulnerability – a mud house and training a project to integrate internally displaced persons (idps) in afghanistan has equipped refugees in hamdard and other municipali- ties with the essentials for everyday life. in addition to providing drinking water wells, sanitary facilities and two primary schools, giz has worked in partnership with the af- ghan ministry of refugees and repatriations to construct mud houses for more than 800 afghan families. and where refugees were keen to construct the houses themselves, the project provided building materials such as clay. implemented by german experts on be- half of the german federal foreign office, the project has reached around 40,000 peo- ple in total. faiz mohammad’s pride and joy is the small garden in the inner courtyard of his two- roomed mud house. his flower bed is filled with herbs, roses and tall canes of virginia creepers. the borders of the courtyard are lined with yellow vegetable oil containers, which mohammad uses to collect water for his plants. behind the flower bed, the family’s two eldest sons are busy building a mud wall for a third room with their bare hands. a train- ing course taught them the necessary skills. while one of the brothers shovels fresh clay, the other shapes the wall and uses a measur- ing tape to check that the work is bringing the required results. thanks to the building course, the brothers can also offer their ser- vices to others and earn money. as unskilled labourers they previously earned at most 250 afghanis per day; now they can get 800 af- ghanis for a day’s work, equivalent to around eur 11.50. ‘internally displaced persons are among the most vulnerable members of the afghan population,’ says project officer yama omari. ‘they often come from poor backgrounds and by fleeing their homes run the risk of slipping into even greater poverty.’ over a million afghans are internally displaced as a result of the violent conflicts since 2004. this does not include those who have been forced to flee from natural disaster or leave their homes for economic reasons. and the numbers are rising. ‘in recent months alone, 6,000 families have arrived in mazar-e sharif as a result of the taliban offensive in kun- safe haven: two girls in hamdard village, a settlement for idps and refugees many afghans have been forced to flee their homes and seek refuge in other parts of the country. but their new start often involves friction and a lack of prospects. in the north of the country, things are now improving for internally displaced persons. good neighbours text marian brehmer photos mustafa najafizada
36 akzente 3/16 right: end of the road: faiz mohammad is now settled in hamdard. his family live in a proper house and his children go to school or have jobs. below: point, game and match: even young children practise volleyball, a popular sport in afghanistan. page 37, top: carrying the hopes of her family: zahra nazari is the spokes- person for the women’s shura and has clear goals for her future. page 37, bottom: important session: at the men’s shura, hosts and idps discuss topical issues. faiz mohammad is also a member.
commitment 37 akzente 3/16 duz,’ says abdul saboor qaderi, director of the relevant provincial office of the minis- try of refugees and repatriations. and an increasing number of refugees are returning from pakistan, which is home to the larg- est afghan population outside the country. these are being expelled, because the paki- stan government considers that the country is no longer able to accommodate 2.5 mil- lion afghans. the internally displaced families set- tle on the outskirts of large towns and cit- ies. their arrival increases pressure on the la- bour market and local infrastructure, which in turn often gives rise to disputes with the local population. women and men seek solutions through dialogue in order to defuse such disputes, the authori- ties in hamdard set up a shura – a traditional neighbourhood council made up of elders from the host communities and refugees. in selecting the delegates, the villagers ensured that all tribes had equal representation: ta- jiks, uzbeks, turkmens and pashtuns. faiz mohammad was a member of the shura from the beginning: ‘whenever there is a problem in the community, we call a meeting and try to find a solution.’ the people of hamdard developed this awareness for a positive dialogue culture as a result of training courses on peaceful conflict resolution, which were implemented by a lo- cal non-governmental organisation. today, disputes are rare. in fact, the host commu- nities recognise that many of the improve- ments to their village are thanks to the ar- rival of idps. five minutes’ walk from faiz moham- mad’s house, seven bearded men take their seat on red cushions for a meeting of the shura. a prayer rug hangs on the wall. the topic for today’s session is the construction of a clinic, which the village urgently needs. mohammad chairs the discussion; he is a good speaker. currently, he explains to his neighbours, villagers have to make their way to the city in an emergency. but transporting the sick and injured along hamdard’s bumpy
38 akzente 3/16 roads is a difficult job. their faces etched with intent, the men discuss whom they should approach with their request. zahra nazari’s dream: to be hamdard’s first midwife the women of hamdard have their own shura, which provides a platform for ex- change on everyday issues and pressing prob- lems. the women then put their concerns before the men’s shura. one of the roles of the women’s council is to provide support for women in particularly vulnerable situations, such as widows and single mothers. individ- ual cases are discussed in the round so as to mobilise collective assistance. the spokesperson for the women’s shura is zahra nazari. although a black headscarf covers the 18-year-old’s face, she is not afraid to make eye contact. nazari’s family came to hamdard six years ago. her father did not have enough money to send his daughter to school. so the family moved from the coun- tryside to the city in search of work. now the daughter is the person on whom the family has pinned its hopes. nazari reads out a list of women’s names. all of them have attended courses organised also available on the akzente app and on the website: faiz mohammad talks about life after fleeing his home. akzente.giz.de/en top: hard at work: female refugees can get training in many different courses. below: carefree education: children receive lessons in reading and writing at the new school in hamdard.
commitment 39 akzente 3/16 > contact helma zeh-gasser > email@example.com by the project in recent years. in addition to reading and writing, the courses offer train- ing in housekeeping, parenting and health. nazari found hygiene training particularly interesting. now her dream is to become a midwife. ‘many families in my neighbourhood don’t allow their women to be seen by a male doctor,’ says nazari. ‘that saddens me.’ since very few women work in the health care pro- fessions, pregnant women are often denied medical treatment. nazari’s aim is to become hamdard’s first midwife so that she can assist women at childbirth. she takes a taxi every day to the centre of mazar-e sharif for her training. she is the first of seven sisters to learn a profession. training in skilled crafts such as carpet weaving or wool spinning has also helped to boost self-esteem among the women of hamdard. a better start in life for the next generation ‘the many changes in hamdard have given us hope,’ says faiz mohammad, gently rock- ing the cradle in which his six-month-old grandson seyed mobin is sleeping. in af- ghanistan prosperity is measured not just in financial terms, but also in the number of de- scendants. mohammad glances at the slum- bering infant with a look of devotion. he hopes that seyed mobin’s life will be easier than his own – right from the start. capital: kabul population: 30.6 million gross domestic product per capita: usd 5901 economic growth: 1.5 per cent1 human development index ranking: 171 (out of 188) source: 1 world bank 2015 the consequences of displacement project: integration of internally displaced people in afghanistan commissioned by: german federal foreign office (aa) lead executing agency: afghan ministry of refugees and repatriations (morr) overall term: 2013 to 2016 over 750,000 people in afghanistan are internally displaced as a result of the country’s political conflicts. this has led to significant problems in the cities and municipalities in which idps settle – in particular because of the lack of living space and the fact that displaced people are often unable to provide for themselves. for this reason, giz is supporting the afghan ministry of refugees and repatriations (morr) in various ways. this includes the construction of temporary accommodation and a new school building, handicraft courses and basic courses in reading and writing, as well as in conflict resolution and citizenship. so far, around 6,000 people have taken part in the training courses, which are designed to help people to help themselves and improve their employment prospects. the courses are implemented by afghan non-governmental organisations under the direction of giz. afghanistan www.giz.de/en/worldwide/24299.html afghanistan pakistan uzbekistan iran tajikistan turkmenistan
for years the country’s farmers clung to tobacco cultivation – which in turn led to a dangerous dependence. now they are switching to sunflowers, peanuts and manioc. malawi goes for diversity text sofia shabafrouz photos tristan vostry
commitment 41 akzente 3/16 i n a darkened room, young men and wom- en are busy grading tobacco leaves by qual- ity. they wear breathing masks and rubber gloves. barnet magombo finds the protective clothing annoying, but he knows that with- out it the work is dangerous. the equipment protects them from toxic nicotine, pesticides and dust. although it is by no means stand- ard in malawi, here at the mwimba college of agriculture it is mandatory. magombo is currently undergoing training at the agricultural college in kasungu district in the country’s central region. the 18-year-old has already learned how to harvest and dry the tobacco cor- rectly. just now, he’s putting processed leaves onto five separate piles and preparing them for delivery. graded tobacco from all over malawi is transported to the country’s four auction halls, where it is bought by interna- tional tobacco companies, the three largest being universal corporation, alliance one and japan tobacco international. tobacco from malawi is used worldwide to make cig- arettes. but demand for country’s principal export has been in decline for years – and so has its value. the 2016 sales season started with low prices. and despite excellent qual- ity, much of the tobacco failed to find a buyer. magombo’s elder sister grows tobacco, and he is following developments with con- cern: ‘the small farmers are increasingly left with goods on their hands.’ previously to- bacco was a crop that would guarantee a better income than any other product. for generations, therefore, many families pre- dominantly grew tobacco and used it as a source of income. now their earnings often do not even cover the costs of labour, seed and pesticides. to compound matters, the country is also battling a food crisis. aside from the impact the el niño phenomenon is having on cli- mate, much of the blame for this must be placed on an agricultural system that has failed to diversify. according to statistics published by the united nations, around 8.5 million people in malawi – around half the population – are facing starvation as a result of crop failures. the prospects are not good, as magombo explains. ‘most farmers are not aware of the risks of monocultures,’ says the prospective farmer. he would advise them to plant other crops along with tobacco, such as peanuts. ‘that way they are less dependent and have a source of food if necessary.’ edible crops in place of tobacco alarmed at the crisis, the malawian govern- ment has introduced measures to make the country less dependent on tobacco sales. by planting other edible food crops, farmers can generate additional sources of income. so in years when tobacco prices are low, they can still feed their families, and at the same time contribute to improved food supplies across the country. fallow tobacco plantations pre- sent a perfect opportunity to farm edible crops – and regular crop rotation means that soils also remain more fertile. giz is advising the malawian govern- ment on how to implement its strategy and boost both production and revenues in the country. ‘a network of agricultural advisors, small producers and local food manufactur- ers will make this possible,’ explains project manager florian bernhardt, outlining the ap- proach of the green innovation centres. these are part of the one world – no hun- ger special initiative launched by the german federal ministry for economic cooperation and development. two agricultural colleges in malawi col- laborate with german experts to train young, motivated farmers like barnet magombo to serve as multipliers. at magombo’s college, an institution funded by malawi’s agricul- tural research and extension trust (aret), 200 students have already graduated as agri- cultural extension officers. as such, they sup- port small farmers across the country with growing not only tobacco and corn, but also sunflowers, peanuts, soya and manioc. the focus is on oil seeds, since these are ideal for further processing within the country’s bor- ders into other goods such as vegetable oil, a product in demand all over the world. the agricultural economist john w. ji- yani walks through the college campus with a look of satisfaction. after the first year of co- operation with german experts, a great deal is already happening. ‘the library has been equipped with technical books and one building has been refurbished,’ says jiyani, outlining the new developments. ‘we also have the use of a laboratory and two oil presses, and the campus is supplied with wa- ter by a solar-powered irrigation unit.’ but most importantly, the college has broadened the focus of its narrow tobacco-based curric- ulum to include the cultivation of oil seeds and manioc – both in theory and in practice. students can now gain extensive experience of both crops out in the training fields. from now on, 120 students will complete the ex- tension training course each year. magombo wants to continue his stud- ies on completing the one-year basic train- ing. in three years he would then be an agri- cultural extension officer. in this role, he wants to pass on his knowledge about alter- native crops and good farming practices to tobacco farmers. and in turn, magombo wants to learn from them. his dream is one day to buy a piece of land of his own, to em- ploy workers and to manage a sustainable farming business. the natural resources college (nrc) at the university of lilongwe in the malawi capital also trains agricultural extension of- ficers. although tobacco farming still fea- tures on the college curriculum, it is no longer found out on the training areas. in- stead, these are now thriving with magnifi- cent sunflowers and manioc. in the irrigated garden which forms part of the campus, the lush, green plants stand in neat rows. the college is trialling a drip irrigation tech- past and future: agriculture student barnet magombo is learning how to farm tobacco. but one day as an advisor he intends to show farmers how to successfully cultivate other crops.
42 akzente 3/16 nique – with great success. ‘with just a small amount of water we can create a major impact,’ says timothy gondwe proudly. clad in a dark suit, the professor is begin- ning to feel the midday heat. pointing to the water tanks equipped with solar pumps, he explains how the college has had to resort to water-saving solutions on account of the impact of climate change. thanks to two new drying facilities – a solar-powered unit for fruit and vegetables and another dryer for cereals – the harvest can be processed re- liably and protected from pests and mould. a motorised hand tractor or rotovator, which is operated like a lawnmower, is also in regular use out in the fields. the nrc sees itself as both pioneer and multiplier: ‘we introduce technical innova- tions, trial them and demonstrate them to farmers’ groups,’ explains gondwe. by adopt- ing this approach, the experts aim to reach as many small farmers across the country as possible: by 2018 it is anticipated that around top: rosemary and sabnet thauzeni need no convincing about the benefits of growing a diverse range of crops. middle: sunflowers are a good alternative to tobacco – the oil produced from the seeds is in great demand. bottom: oil seeds undergo further processing within the country’s borders (left). corn is already a common crop in malawi (right). also available on the akzente app and on the website: changes to malawi’s fields akzente.giz.de/en
commitment 43 akzente 3/16 > contact florian bernhardt > firstname.lastname@example.org 17,000 families will be familiar with the new methods. the village of khwidzi is just a few kilo- metres from the college. the small farmers who live here listen to the advice of the ex- perts. until now, the village has applied sim- ple farming practices with a clear distribution of roles: the men work the fields with picks and the women fill buckets of water from the wells. the whole village was excited to see the college’s hand tractor in action, because it rendered the task of rotovating the fields much easier. there are already plans for a so- lar pump for the village’s newly developed water source. the farmers are hoping these changes will result in improved harvests. exchange between farmers and students students from the agricultural college regu- larly visit the village. they gather practical ex- perience from the villagers, and in turn make farmers aware of new techniques and ap- proaches. they pass on what they have learned in their studies – such as the use of compost to cut the cost of expensive fertilis- ers. rosemary and sabnet thauzeni, a farm- ing couple from the village, have already ac- cumulated a small compost heap. sabnet thauzeni heads up a group of farmers and has just returned from a training session. ‘many farmers who only make losses with to- bacco are now switching to the less time-con- suming and more cost-effective farming of oil seeds,’ he reports. the thauzeni’s farm is already very di- verse: they grow peanuts, corn and soya, in addition to keeping hens and goats. sabnet thauzeni needs no further persuasion: ‘the new crops and improved techniques are really helping to boost an entire village.’ capital: lilongwe population: around 17 million gross domestic product per capita: usd 3811 economic growth: 3 per cent1 human development index ranking: 173 (out of 188) source: 1 world bank 2015 new knowledge project: green innovation centres for the agriculture and food sector commissioned by: german federal ministry for economic cooperation and development lead executing agency: malawian ministry of industry and trade overall term: 2015 to 2019 never has so much food been produced and harvested as today. yet all around the world there are millions of people with too little to eat. one key to solving this problem lies in modern small-scale farming. the green innovation centres exist to enable farmers to learn new approaches. these include improved refrigeration chains or more effective fertilisers. in addition, farmers are introduced to new forms of cooperation, setting up producer cooperatives and interest groups. giz works on behalf of the german federal ministry for economic cooperation and development to network specialist partners in the country. in addition to the facility in malawi, green innovation centres operate in benin, burkina faso, cameroon, ethiopia, ghana, india, kenya, mali, nigeria, togo, tunisia and zambia. malawi www.giz.de/en/worldwide/32209.html malawi mozambique zambia tanzania
45 akzente 3/16 commitment t he squeals are ear-piercing as a worker clad in white protective clothing and rubber boots and carrying a bucket full of fodder enters the building. even from out- side, the smell is unmistakable: the sty is full of pigs. juan carlos saenz peers inside through the open door. with over 25,000 animals, his pig breeding business in carta- go, central costa rica, is one of the biggest in the country. at the same time, saenz’ sows and pig- lets are the number one producers of biogas in costa rica – which of all the states in cen- tral america is a paradigm of environmental friendliness. nevertheless, life is not always easy for the private producers of renewable energy. costa rica’s many state-run hydro- power plants appear to be meeting require- ments – but only at first sight. in summer 2015, for example, the state utility company announced that the coun- try’s energy needs had been met for 75 days entirely with renewable energy – without oil, without natural gas, without nuclear. the an- nouncement marked a remarkable achieve- ment. so with around 90 per cent of its clean energy coming from hydropower, why invest in solar and biogas plants? clean biogas from stinking slurry it is a question which many decision-makers in politics and the energy industry seem to be asking themselves. but there are serious prob- lems with the country’s dependence on the turbines installed at reservoir dams and on fast-flowing waters. costa rica is drying up. this is due in part to the el niño phenome- non – but to a much greater extent to climate change, which is altering precipitation pat- terns. although average rainfall overall is no less than it used to be, the distribution is dif- ferent. periods of heavy rain are now followed by longer dry spells. without rainfall, many hydropower plants are unable to operate effectively and electricity production dwindles. that means costa rica has to fall back on fossil fuels. these are not only expensive, they are also harmful to the environment – and put at risk the country’s goal of becoming climate-neu- tral by 2021. producers like saenz, whose company porcina americana breeds and slaughters pigs, prefer to rely on alternatives. each year, his farm accumulates thousands of cubic me- tres of slurry and slaughterhouse waste, which the company converts into biogas in a new facility. the methane gas it releases is used to power the electricity generator. the biogas plant has already saved as much as 60 per cent of his farm’s energy costs. further- more, its use dramatically reduces greenhouse gas emissions, since escaping methane gas is considerably more harmful to the atmos- phere than carbon dioxide. so the hefty investment of usd 1.5 mil- lion for porcina americana’s biogas plant has been worthwhile. after just three years the plant will have paid for itself. it would be even more lucrative if the company were able to sell its electricity to the national energy utility. however, the state has no plans for this at present. it only aims to support com- panies on the path to energy self-sufficiency – which is why companies can feed surplus energy into the grid and then take it out again when their own demand increases. business once on the brink of bankruptcy saenz might never have come up with the idea of the biogas plant if he had not had problems with his stinking slurry. this ended up in open cesspits, exposed to the full inten- sity of the central american sun. the organic waste not only polluted the atmosphere, it also contaminated nearby waterways. neigh- bours filed an official complaint; by 2011 the business was on the brink of collapse. that was the point at which saenz asked giz for support, particularly as experience turnaround: juan carlos saenz almost had to close down his pig breeding business. now, thanks to his new biogas plant, his thoughts have turned to expansion. renewable energy, particularly hydropower, plays a major role in central america. now, biogas plants are also generating clean energy, as a pig breeding business in costa rica is demonstrating. electricity from the pig farm text hauke friederichs photos jose díaz
46 akzente 3/16 with biogas plants in costa rica at the time was limited. today the future looks great, says saenz, and he is even in a position to ex- pand his business. ‘if it hadn’t been for the biogas facility, we would have had to close down,’ the company boss explains. ‘the substrate from the pig breeding fa- cility is ideal for use in biogas facilities,’ ex- plains ana lucía alfaro of giz. by this she means the animal excrement as well as the blood and innards from the slaughterhouses. not only can it be used to generate electricity, it also cuts waste to virtually zero. today the only places that smell are the piggeries themselves. ‘but it’s nothing com- pared to what it used to be like,’ says alfaro, who previously worked at the costa rican ministry of energy. now, based in the capital san josé, she coordinates the local activities of two regional programmes for renewable energy that giz is implementing on behalf of the german federal ministry for eco- nomic cooperation and development. the objective is to promote clean energy in cen- tral america, which includes building solar facilities and biogas plants. similar activities are also in progress in el salvador, guate- mala, honduras, nicaragua and panama. another shining example of green en- ergy production in costa rica can be found just 50 kilometres from the pig breeding fa- cility in alajuela, the country’s third-largest city. here, the football club liga deportiva alajuelense (lda) has installed a solar en- ergy system on the roofs of its stands. the electricity generated is sufficient to meet the needs of the entire 17,000-seater stadium, in- cluding its new floodlights. clever financing model boosts revenues the club needed a floodlighting system so that its matches could be broadcast on televi- sion and provide a source of income. as one of the country’s most successful clubs, lda also takes part in international compe- titions. but the floodlights initially pushed the club’s annual electricity bill up by over usd 70,000 – an enormous sum for a club with income well below that of the average german bundesliga team. lda urgently needed a financing option. support came from giz, who calculated the potential of putting a solar energy system on the roof and advised lda on its installa- tion. the costa rican association of solar en- ergy (acesolar) also provided the club with support. the experts then came up with an interesting financing model: the system was top: happy entrepreneur: the biogas plant in the background generates clean energy for saenz’ business. bottom: effective solution: the plant no longer produces unpleasant odours thanks to the gas-tight slurry storage tanks.
47 akzente 3/16 commitment > contact manfred haebig > email@example.com bought by the first costa rican energy service company, a private financing agency which re- ceives capital from an investment fund for re- newable energy and energy efficiency. the agency now sells solar energy to the club at at- tractive low prices between 1,000 to 2,000 dollars per month. in six years the system will have paid for itself – after which time it will become the property of lda. flagship projects: imitation is the sincerest form of flattery ana lucía alfaro – a keen supporter of lda – is particularly pleased about the stadium’s solar facility. her favourite club is now also a pioneer in the use of solar energy. and since the club is part of a flagship project, it is per- mitted to sell solar energy to the national electricity providers. so the club earns money selling green energy, and at the same time saves around 550 tonnes of carbon dioxide per year. ‘projects like these send out an impor- tant message to the whole of costa rica,’ says jürgen popp of giz. and sure enough, more companies are already lining up. the meat producer el arreo, for example, is in the pro- cess of building a biogas plant. this will ena- ble the company not only to generate energy, but also to use it to power boilers which cur- rently still run on fuel oil. and the country’s largest brewery has also recently switched to solar power and a generating plant fuelled by wood pellets. popp is already working on the next idea: costa rica’s pineapple plantations cur- rently give rise to thousands of tonnes of un- used organic waste. scientists are now re- searching whether pineapple waste may also be suitable for biogas plants. if so, costa rica could soon meet its year-round electricity needs entirely from renewables, further re- duce emissions and perhaps surprise the world with another success story on climate change mitigation. capital: san josé population: 4.9 million gross domestic product per capita: usd 10,6301 economic growth: 2.8 per cent1 human development index ranking: 69 (out of 188) source: 1 world bank 2015 countering climate change project: renewable energies and energy efficiency in central america commissioned by: german federal ministry for economic cooperation and development lead executing agency: general secretariat of the central american integration system (sg-sica) overall term: 2010 to 2016 expensive, environmentally harmful crude oil still meets around one third of the energy requirements of the central american countries of costa rica, el salvador, guatemala, honduras, nicaragua and panama. although hydropower is well established as a renewable energy source, it is under threat from climate change. for this reason, giz is helping to increase the use and range of renewable energy in the region and to improve energy efficiency. it does this by promoting private and public initiatives and investments. in addition, it strengthens regional exchange with the aim of improving underlying conditions for renewable energy and energy efficiency. giz also develops basic and further training measures for technical experts, for example, as well as for decision-makers and managers from ministries and public administration. costa rica www.giz.de/en/worldwide/13518.html costa rica panama honduras nicaragua
illustration: teamwork arts/jaipur literature festival (page 48, top), photo: shigeo arikawa (page 48, below) 48 akzente 3/16 the moving image film the international documentary film festival amsterdam has built a reputation around the world for selecting films that experiment particularly creatively with the documentary genre. just one example is the japanese-dutch film ‘am i dreaming of others, or are others dreaming of me?’ (photo) by japanese director shigeo arikawa, which was showcased at the 2015 festival. the film tackles the question of how dreams and the passage of time transform human experiences and perceptions of reality. the festival runs from 16 to 27 november 2016 www.idfa.nl the spoken word literature january 2017 will see authors and literary enthusiasts from around the world heading to jaipur, capital of the indian state of rajasthan, for the 10th jaipur literature festival. the festival is unusual in having free entrance to all events. over the years, thousands of people have taken this opportunity to attend readings and discussions with authors ranging from promising newcomers to nobel laure- ates, including nigeria’s wole soyinka and the south african j. m. coetzee. the festival runs from 19 to 23 january 2017 www.jaipurliteraturefestival.com editor’s picks
women’s economic empowerment in technical assistance programmes available in english brigitte späth empowering women to participate on an equal footing in economic life is a key focus of international cooperation. this publication presents a series of case studies of success- ful initiatives in countries including algeria, bangladesh, kenya and the philippines. social cohesion and integration available in german timo weinacht, christiane erkens where refugees and the population of host communities live side by side, there is often a high level of potential for conflict. taking this as its context, the publication presents methods used in inter- national cooperation to prevent violence and resolve conflict. giz publications innovations and emerging trends in agricultural insurance available in english ulrich hess, peter hazell traditional risk manage- ment fails to provide most small-scale farm- ers in developing countries with an adequate safety net. this brochure provides an over- view of promising new forms of agricultural insurance and discusses the challenges and the policy framework required. litprom recommends these publications can be downloaded or ordered free of charge from www.giz.de/publications 49 akzente 3/16 info dust novel ngugi wa thiong’o first put kenya on the literary map of the world, and now, yvonne adhiambo owuor boldly reworks that map. her language is freighted with meaning and metaphor, and there is a shim- mering sense of mystery that draws the reader into the intellectual world of east africa without over-simplifying com- plex situations. this novel is an intimately intense panorama of the country’s recent history, including the mass killings of british colonial rule. ilija trojanow, author yvonne adhiambo owuor, kenya granta books, 384 pages the vegetarian novel yeong-hye’s husband thinks she is boring and average; in fact, that’s ex- actly what he likes about her. but then she decides to become a vegetarian. it’s an unprecedented act of rebellion, and no- body understands why she has taken this step. yeong-hye’s response is a bewilder- ing flight into madness as she imagines herself mutating into a tree. this is the story of one woman’s disintegration told from three external perspectives – disturb- ing, but formidably impressive, from start to finish. anita djafari, general manager of litprom han kang, south korea translated from korean by deborah smith hogarth, 208 pages litprom – the society for the promotion of african, asian and latin american literature – provided these reviews for akzente. the titles were selected from litprom’s list of best new novels. www.litprom.de
working in ukraine enables christiana hageneder to combine two of her passions: energy efficiency and eastern europe. while still a student, she studied russian in her spare time, a commitment that is now proving invaluable. hageneder joined giz in kiev in 2012, having previously worked for an austrian think-tank. she manages energy efficiency projects for the company. as hageneder, who qualified initially as an architect and then completed a further university degree in building op- erations and energy management, says, ‘it takes very little time to build a house, but planners and architects often forget that the house will be there for decades.’ her work therefore takes in not only renovation projects but also new builds, which are designed from the outset to be energy-efficient. en- ergy efficiency is crucial in ukraine, where consumers have faced increases in their energy bills of up to 200 per cent since 2013. a vital part of hageneder’s work is providing sup- port to national and municipal authorities. since 2014, ukraine has had an association agreement with the european union, and hageneder advises the government on adapting local legislation to comply with eu directives. she supports local mayors by training energy managers in techniques for continu- ally auditing and improving the energy consumption of municipal buildings, such as schools and hospitals. energy expert giz is always looking for experts for its projects. interested? why not visit our ‘jobs and careers’ page: www.giz.de/careers. christiana hageneder, introducing
s ustainability a look back at a project and its r e s u l t s project: combating aids and sexually transmitted diseases in zambia commissioned by: german federal ministry for economic cooperation and development term: 2012 to 2014 then: almost one in every seven zambians was infected with hiv. women and young people were particularly at risk, as many were unaware of the risks of unprotected sex, while the lack of access to contraception was also contributing to a high rate of teenage pregnancy. per year, one or two young women out of every hundred in zambia’s southern province became pregnant while still at school. this had an impact on their education, as most had to drop out of school temporarily or permanently after giving birth. now: more than 10,000 people living in the livingstone district of southern zambia now have a much better understanding of hiv/aids. a participatory ‘training circuit’ provided an informal way to introduce participants to the high risk of hiv infection, who now know how to protect themselves. the circuit was set up in secondary schools and used by students, teachers and parents alike. it was also used at motorway service stations, providing information for lorry drivers and sex workers. hiv testing and advice were also made available. in 2013, almost one resident in six in the district took an hiv test. since 2009, the national rate of new infections with hiv has fallen to just under 1 per cent. www.giz.de/zambia development in the face of crises climate change, refugee flows and armed conflict are just some of the multiple challenges facing the international community. the 2030 agenda for sustainable development provides a policy framework for tackling these challenges, but preview akzente issue 1/17 how can its objectives best be met? how can development be achieved in times of turbu- lence? how can we provide access to education, water, energy and food for all? answers to these and other questions will be provided in akzente 1/17. 51 akzente 3/16 publisher: deutsche gesellschaft für internationale zusammenarbeit (giz) gmbh registered offices: bonn and eschborn, germany • friedrich-ebert-allee 36 + 40, 53113 bonn, germany tel.: +49 228 44 60-0, fax: +49 228 44 60-17 66 • dag-hammarskjöld-weg 1-5, 65760 eschborn, germany tel.: +49 61 96 79-0, fax: +49 61 96 79-11 15 sabine tonscheidt, director of corporate communications email: firstname.lastname@example.org internet: akzente.giz.de /en responsible: anja tomic, deputy director of corporate communications (giz) content concept and editing: giz: uta rasche (editor), kerstin nauth frankfurter societäts-medien gmbh: helen sibum (project management), friederike bauer, judith reker, oliver hick-schulz (layout), corinna potthoff (photo editing) english translation: judith steinau clark, hillary crowe, janet fraser, jodie mcgilvary, alan seaton; karl stellrecht (giz language services) proofreading: textschrittmacher, lübeck, germany graphic design/lithography: frankfurter societäts- medien gmbh, frankfurt, germany printed by: druckerei lokay e. k., reinheim, germany printed on: arctic volume, certified to fsc standards maps: giz/ira olaleye the maps are for information purposes only and do not constitute recognition under international law of boundaries and territories. giz does not guarantee in any way the current status, accuracy or completeness of the maps. all liability for any loss or damage arising directly or indirectly out of their use is excluded. cover: getty images/peepo all images: giz unless otherwise stated copy deadline: october 2016 published: quarterly current issue: november 2016 issn: 0945-4497 articles by individual authors do not necessarily reflect the opinions of the publisher. akzente has received several awards for its high-quality journal- ism and design. in 2016 it won the fox award in gold and the fox visual award in silver. akzente photos: alexey furman (page 50), thomas imo/photothek.net (page 51) tel.: +492284460-0, fax: +492284460-1766 tel.: +49619679-0, fax: +49619679-1115
people are living longer, healthier lives, including in developing countries. pro- gress has been made in the fight against child mortality, among others. but health systems are often still far from robust. akzente.giz.de/en