NEWS FROM THE ASIAN DEVELOPMENT BANK JUNE 2004

The Millennium Development Goals Will Asia and the Pacific Achieve Them? www.adb.org/review

June 2004 1 Volume 36, Number 3 June 2004

HER FUTURE ADB is well placed to continue its role as a valuable global partner in helping developing member countries achieve the MDGs by 2015 Richie Abrina MILLENNIUM DEVELOPMENT GOALS 26 HEALTH Good 32 Thirst for Change 6 OVERVIEW Staying on Track for 2015 While Health Begins at In 1993 the people of Phnom Penh lacked a not new for ADB, the MDGs represent shared, measurable, Home Battling ingrained and monitorable goals that DMCs are seeking to achieve in and unhealthy lifestyles reliable water supply but partnership with ADB through community all that has changed partnerships with the health 8 ANTICORRUPTION A Black and White Issue establishmentis helping 34 Fatal Attraction Corruption in Asia and the Pacific is often obscured by lower maternal and infant Steps to counter the spread a haze of secrecy and is difficult to measure mortality rates, and reduce of HIV/AIDS are showing disease levels in rural results in the Greater Mekong Subregion 12 NUTRITION Rice Power Trials to gauge the Indonesia effectiveness of boosting the iron content of rice are showing encouraging results that could drastically decrease micronutrient deficiencies Graham Dwyer 14 RURAL DEVELOPMENT A Time for Change Learning innovative ways to manage their environment has created new opportunities for poor rural dwellers in Fujian Province in the People’s Republic of China

20 EDUCATION Back to Basics With decentralization putting the onus on education in Indonesia in the hands Break time at an Indonesian school...... 20 of district offices, schools, and communities, a project is aiming to turn this challenge into an opportunity 29 Fighting Ignorance DEPARTMENTS Traditional medicine 10 LAW MATTERS 23 LEADERSHIP Women Power The Philippines women are key to is one of two Asian countries setting the standards in promoting cleanliness 18 ADB BOOKSTORE women leadership positions and better health 19 WEB WATCH 24 Women Learn to Lead Women in Bangladesh, 30 Healing Cambodia’s Nepal, and Pakistan are overcoming discrimination and Health Care A new 19 NEWS FOR NGOs numerous obstacles to become leaders in their communities program is helping elevate Cambodia’s health care service from disarray into a ADB Review, Office of External Relations, Asian Development Bank, P.O. Box 789, system the community can 0980 Manila, Philippines; E-mail: [email protected]; Fax: (632) 636-2648; afford and trust Web site: http://www.adb.org/review. In this publication, “$” refers to US dollars. Cover photo: Richie Abrina; Photo illustration: Ram Cabrera 2 June 2004 Ram Cabrera ACHIEVING THE MILLENNIUM DEVELOPMENT GOALS Realistic, Possible? Local partnership, harmonization, and commitment all critical for success

By Graham Dwyer External Relations Specialist How does the Millennium Campaign and your work as UN Special Ambassa- rna Witoelar, the former Indonesian Minis- dor for the MDGs fit within the con- ter for Settlements and Regional Infrastruc- text of the UN system, and what does ture, was named the first United Nations your work entail? (UN) Special Ambassador for the Millennium Within the UN system there are two main Development Goals (MDGs) for Asia and the supporting efforts to enable countries to EPacific in September 2003. UN Secretary-General Kofi reach the MDGs. One is the Millennium Annan expressed the hope that her “talent and pres- Project, which is helping develop the right ence as part of the MDG Campaign will contribute to policies to reach the goals—whether in eco- reach the hearts and minds of people around the nomics, trade, or development. The other world.” is the Millennium Campaign, which is During a visit to ADB, she outlined in an interview Eric Sales facilitating campaigns to make sure that Erna Witoelar for ADB Review the challenges ahead for the Millen- the process is catalyzed. Both units are di- UN Special Ambassador nium Campaign, launched in November 2002 to build for the MDGs for Asia and rectly under the Secretary General. partnerships with stakeholders to mobilize support for the Pacific This is a new global solidarity momen- achieving the MDGs. tum that must go beyond government to

June 2004 3 help countries reach the goals and increase commitments to reduce poverty, which in SHARED CONCERN The MDGs are holistic turn will help in achieving the rest of the and interrelated—the process of working together at national, regional, and global goals. together at national, regional, and global levelslevels isis veryvery importantimportant My role is to get top-level commitment and generate public awareness and pres- sure. I am campaigning among govern- ments, civil society, parliaments, uni- versities, the private sector, and all other players; meeting government poverty reduction teams and national planning boards; talking at universities; giving interviews; and appearing on talk shows.

What commitments are you looking for from the region’s developing coun- tries to further their MDG agenda? As the goals are holistic and interrelated, the process of working together in partner- ships at the national, regional, and global levels is very important. To achieve the MDGs, all stakeholders have to participate actively—not just governments. If we con- tinue to conduct our development work in a business-as-usual way, many of us [de- veloping countries] won’t be able to reach the goals. Governments need to be constantly re- minded of the commitments they have al- ready made to achieve the goals and that they should be really serious and main- stream them in existing work. But the real implementation has to happen at the lo- cal level. The better local governments are able to target and develop the right inter- ventions, the better will be the results on poverty reduction, health, sustainable de- velopment, and education.

Many countries actually have money

to reach the goals, it is just that we have Ram Cabrera not been using it in an effective way. So “ good governance is important, like account- Aid is not effective if every donor has its own ability, participation, transparency, and minimizing corruption. strategy, each accompanied by complex procedures that “overburden poor countries’ institutional capacity What progress have you seen in the region toward achieving the goals? Some countries are more advanced in the velopment of the environment. In these faster we can reach them. MDG process than others. Some have al- cases, they need to go beyond the goals to What needs to be sharpened is our ca- ready reached certain goals in a short pe- develop “MDG plus.” pacity to benchmark and note progress. riod. But they have not viewed them in a On Goal 3, gender and empowerment There has been little work on this in the holistic way that could then be used to of women, the target in the Philippines is past because many of our countries have reach the other goals. not only to eliminate gender disparity at weak statistical capacities. Countries like Malaysia, for instance, school level but also in terms of reproduc- have already reached many of the goals and tive rights, so the country can develop its The Millennium Compact in Monterrey will be able to reach all of them by 2005, own targets based on the MDGs. The bet- stated that international finance insti- except probably Goal 7 on sustainable de- ter we are able to define our targets, the tutions (IFIs) should put the MDGs at

4 June 2004 THE INTERVIEW the center of their country strategies a big turnover of policymakers in these What kind of reception have you and programs. Is this happening? countries, so there is a constant need to received from governments and the I don’t think so. People know the theory, involve them again in understanding all public in your first six months of work people know the concept, but it is still at this knowledge, instead of reinventing the on the MDG issue? the conceptual level. In theory we know wheel. ADB at the regional level could co- I’m pleasantly surprised to see how fast that to reach the MDGs we have to be ordinate better with other regional players people can be “MDG-ized.” As soon as more holistic. But support from IFIs is to be able to catalyze peer-to-peer learn- people realized how the MDGs are linked still sectoral. So the international com- ing of countries in this region. with their work, concerns, campaigns, they munity needs to coordinate better among usually become interested and enthusias- itself. Have you encountered much official tic, despite some initial skepticism. The better the partnerships between cynicism about achieving the MDGs? Governments’ reactions vary, especially re- IFIs and multilateral and bilateral donors, There is skepticism in developing coun- garding the need to be more participatory the better will be the use of resources. We tries of Asia and the Pacific that it is all in making the MDG reports. Some are have to be able to improve the use of exist- just a way of packaging old stuff so that quite reluctant to involve civil society from ing resources, loans, and grants to make the UN, the international community, the beginning for several reasons. Some are them more effective. World Bank, and other IFIs can make more still coordinated by the foreign ministry— Creditors of ADB, donors, IFIs, and the business for themselves. maybe they don’t realize that the MDGs UN are increasingly reforming their pro- There is also skepticism [in the devel- are not just the governments’ pledges to grams and processes toward achieving the oped world] that national governments in the international community, but, most MDGs. But if we want to reach the goals developing countries are not committed important, they are an obligation to their by 2015, we all need to coordinate efforts. enough to the goals because they face so own people. Aid is not effective if every donor has its many distractions from internal political It’s amazing how little information on own strategy, each accompanied by com- problems. MDGs exist in most of the countries for plex procedures that overburden poor coun- We have to stress that this is a global ordinary people. The MDGs are so far only tries’ institutional capacity. We must solidarity for a new approach to partner- owned by the central governments, UN, ensure the implementation of the Rome ships with better ways of measuring and donor communities in the country.

Declaration on Harmonization. progress. Then we can move forward and A lot still needs to be done to make them When I was in the Government, I was each country can improve its ways of doing owned at the local level. It’s at the local very upset because ADB had its own pov- things to reach the goals. And even after level that poverty exists, and it’s at the erty strategy, the World Bank had its own they have reached the goals, they can move local level that the MDGs can be achieved poverty strategy, and the Department for forward from there, because the goals them- through a holistic and integrated develop- “ International Development of the United selves are very elementary and very basic. ment approach. „ Kingdom had its own poverty strategy for the same country—Indonesia. We were just observers of this process. It It was a case of their experts debating among themselves was a case of their experts debating among themselves—about us. We don’t have“ ownership of these processes. It is very im- portant that we have ownership. They don’t need to work for us, they have to work with us.

How would you like to see ADB involv- ing itself more in the MDG agenda? ADB should readjust its existing programs and existing approaches to better answer individual countries’ needs in reaching the MDGs. It also needs to gradually move from direct local-level project intervention to more strengthening of national and pro- vincial capacity to develop and really implement pro-poor policies because that is our weakness. ADB has a lot of knowledge generated SHARED TASK Poverty exists at the over many decades. We could make more locallocal level,level, andand itit isis atat thisthis levellevel use of this. Our national governments need that the MDGs can be achieved

to be educated on good practices. There is Rollie del Rosario

June 2004 5 OVERVIEW STAYING ON TRACK FOR 2015 While not new for ADB, the MDGs represent shared, measurable, and monitorable goals that DMCs are seeking to achieve in partnership with ADB

By Bruce Purdue Global Benchmarks Head, Results Management Unit ADB, with the rest of the global develop- ment community—including developing he Asian Development Bank countries—endorsed the MDGs as appro- (ADB) takes pride in its role in priate global benchmarks for tracking the helping its developing member key elements of poverty reduction. Since countries (DMCs)—and the 2002, ADB has taken steps to help its working on creating stronger links between entire Asia and Pacific region— DMCs achieve the MDGs and related out- ADB programs and the MDGs and related achieveT the Millennium Development comes. outcomes; raising awareness within ADB Goals (MDGs) by 2015. The MDGs are The MDGs represent a fundamentally to ensure that the momentum of MDG- eight goals, supported by 18 time-bound important global consensus on the key related actions is maintained; and helping targets and 48 measurable indicators that steps that must be taken to seriously tackle mobilize sustainable resources (including outline objectives for poor developing coun- poverty and its attendant evils. The will- local resources) to advance the MDG tries. They aim at measurable progress to- ingness of ADB and DMCs to become in- agenda. ward eradicating some key barriers of volved in the global struggle to achieve the After years of debate on whether devel- human development: poverty, hunger, dis- MDGs will increase the pressure on devel- opment agencies have lost their way, a col- ease, illiteracy, environmental degradation, oped countries to play their part, particu- lective development mission appears to and discrimination against women. larly when it comes to trade, elimination of have made a significant breakthrough with The MDGs are not “new” for ADB— subsidies, and the high ideals expressed in the MDGs. there is much continuity in our work from MDG 8—the global partnership for devel- The MDGs can provide a great oppor- the past. However, the MDGs do represent opment. tunity to an institution, such as ADB, to shared, measurable, and monitorable goals. In continuing to collaborate to acceler- have clear and concrete answers to those What is clear is that ADB must be rigorous ate progress toward the MDGs, ADB is al- nagging questions on the relevance of de- and systematic in how it addresses the ready addressing initiatives such as velopment work and the projects that we MDGs in planning, formulating, imple- identifying jointly with each DMC the finance. menting, and refining our country strate- MDGs most relevant to its stage of devel- gies and programs. opment and the priority actions to be taken, Good Intentions With more than 700 million people in in concert with other development partners. ADB has always pursued the good inten- Asia and the Pacific living on less than $1 tions enshrined in its Charter, policies, and a day, and more than two thirds of the Core Competencies projects. However, the problem is often be-

world’s poor living in this region, ADB faces ADB is also focusing on core competencies, ing able to ensure a credible check on how a great responsibility to help its poorer such as regional cooperation and the provi- those good intentions are pursued. Which

DMCs do their best to achieve the MDGs sion of global and regional public goods. It is of the many challenges facing DMCs do we by 2015. ADB also understands it must aim to better mainstream MDGs in policies “ and actions, and help build consensus on The MDGs represent a fundamentally important MDG priorities with our DMCs. We must also aim for better consistency in how our global consensus on the key steps that must be taken to country strategies and programs address seriously“ tackle poverty and its attendant evils the MDGs.

6 June 2004 dicators reflecting the MDGs and related outcomes. ADB has made considerable efforts to Ram Cabrera integrate the MDGs into its operations, including adopting policies and initiatives to facilitate the achievement of the MDGs. Yet, many challenges remain for us to effec- tively support an accelerated MDG agenda. For example, with the adoption of the Poverty Reduction Strategy, poverty reduc- tion became ADB’s overarching goal and in 2002 ADB endorsed the MDGs as the benchmark regime for assessing progress in the key areas of poverty reduction. One major challenge is to better articu- late the likely impact of ADB’s operations on that set of MDG targets that are most directly linked to ADB operations, having regard to the efforts of DMCs and other de- FACING THE FUTURE Many challenges velopment partners. remain for ADB to effectively support We must analyze the linkages among an accelerated MDG agenda the DMC’s national poverty reduction strategy (or equivalent), the MDGs, and tackle? How do we know the fight against ADB’s lending and nonlending interven- poverty is being won, and if so, how do we Millennium Development tions. In some cases, it may be possible to measure ADB’s effectiveness in this? How Goals: Achievable? describe a direct link between a proposed can we go beyond repetitive statements of project and MDG targets/indicators for the good intentions to factual, meaningful, and Goal 1 Eradicate extreme poverty country. In other cases, there may be inher- understandable evidence of real results? and hunger ent problems in trying to link ADB inputs How do we get these important messages directly to MDG outcomes—especially to our stakeholders, including our DMCs Goal 2 Achieve universal primary when there are multiple players—all with and civil society? education important roles. Yet, this type of analysis These are global challenges, and major must be tackled in collaboration with each Goal 3 Promote gender equality and questions for ADB. DMC. This is essential to managing for empower women However, the framework enshrined in development results. the MDGs can provide us with the means Goal 4 Reduce child mortality There is much to be done in helping to demonstrate our contribution to devel- ADB DMCs strengthen research and diag- opment effectiveness outcomes in plau- Goal 5 Improve maternal health nostic capacity to help them establish the sible, concrete, and measurable ways. linkages mentioned above. Without such Goal 6 Combat HIV/AIDS, malaria, Recent studies, such as the United sustainable capacity building, true MDG and other diseases Nations Development Programme’s Human progress will be jeopardized. Development Report 2003 and the report of the Goal 7 Ensure environmental A global review of the MDGs will take United Nations Economic and Social Com- sustainability place in 2005. This assessment of progress mission for Asia and the Pacific on Promot- will help create a clearer vision of how ADB ing the Millennium Development Goals in Asia Goal 8 Foster global partnership must continue to meet the challenges in and the Pacific (2003), highlight the need to for development the following decade to push forward accelerate progress toward achieving the progress toward achieving the MDGs. MDGs. In other words, there is a need for a tinuing efforts to support capacity build- While we may have already reached some renewed commitment by development in- ing and data collection at the country level. success, we need to identify additional ways stitutions to contribute to the emerging glo- However, ADB still faces challenges at for ADB’s efforts to link into achieving the bal partnership to help achieve the MDGs. both country and regional levels in helping MDGs. In addition to our work on country strat- accelerate progress toward the MDGs, par- We cannot afford to be complacent. egies and programs, ADB also continues to ticularly in the case of countries identified With this drive for demonstrating results take steps in relation to economic and sec- as “top priority” and “high priority.” A so- and our ongoing commitment to poverty tor work, and regional initiatives to help lution to this could be even greater focus at reduction, ADB is well placed to continue DMCs achieve the MDGs and related out- country level to find better linkages be- its role as a valuable global partner in help- comes. This has been combined with con- tween ADB projects and the targets and in- ing DMCs achieve the MDGs by 2015. „

June 2004 7 A BLACK AND WHITE ISSUE Corruption in Asia and the Pacific is often HEAVY BURDEN The poor too obscured by a haze of secrecy and is difficult to often pay the price of corruption measure. Evidence suggests it is widespread and a direct challenge to meeting the MDGs by diverting funds meant for education, health care, and infrastructure that could help lower poverty

By Eric Van Zant lennium Development Consultant Writer Goals. Because corruption robs funds from programs eciding what is corruption to improve health, educa- is more art than science: tion, and other basic ser- many people may find it vices, the poor too often difficult to define it ex- pay the price. The World actly, but they know it when Bank Institute estimates Dthey see it. that child mortality can Graft, fraud, nepotism, and bribery have fall as much as 75% when been around for an eternity. In individual countries tackle corrup- cases they can even appear to be benefi- tion and improve their rule cial. Far from suggesting smooth operation, of law. however, widespread corruption is a symp- “While one may think tom of malfunction that can hinder foreign of examples in which some investment and restrict development. firms/people are made bet- “Rampant corruption demonstrates ter off by paying a bribe... that the system is broken—resources are the overall effect of corrup- not going where they should go,” says tion on economic develop- Michael Stevens, ADB Principal Audit ment is negative. This is Specialist, Office of the Auditor General. just as true in Asia as else- It is estimated that one third of public where,” writes Shang-Jen ADB file investment in many Asia and Pacific coun- Wei, the Harvard-based tries is squandered on corruption. Keeping economist in a study of More than $1 trillion is paid in in mind the difficulty of measurement, corruption published in ADB officials suggest it can cost as much 1998. bribes each year World Bank Institute estimate as one sixth of a country’s potential gross domestic product. Reducing Harm Director of ADB’s Governance and Regional In a new study, the World Bank Insti- Reducing corruption to less damaging Cooperation Division. Just how long it tute estimates more than $1 trillion is paid levels is difficult and can take a long time. takes, he says, will depend on setting up in bribes each year. Daniel Kaufmann, the It requires leadership, the setting up of an “environment for change.” Institute’s director for governance, says the independent watchdogs, establishment of The ADB-Organisation for Economic figure estimates bribes paid worldwide in policies and laws that are adhered to, and Co-operation and Development (OECD) both rich and developing countries. It does public sector reform. Anticorruption Initiative, started in 1999 not include embezzlement of public funds “You will need many generations to deal in response to the turmoil set off by the or theft of public assets. with the problem. Things are bad, and some Asian financial crisis, is helping set a tone The issue goes to the heart of the Mil- are saying ‘getting worse’,” says Jak Jabes, for change. Under this initiative, 21 coun-

8 June 2004 ANTICORRUPTION tries have signed the Anticorruption Ac- government, a signatory to the ADB-OECD which will provide improved quality con- tion Plan, including Bangladesh, India, In- plan, has charged a minister and a promi- trol of civil works in infrastructure projects. donesia, and Philippines. The four are nent businessman with graft. It has also ADB is supporting reforms to streng- ranked among the region’s most corrupt brandished a list of 18 other high-ranking then the Philippines’ nonbank financial nations by numerous surveys, including officials who could face similar charges. sector through a $150 million loan pro- by Transparency International. “Political will is absolutely essential. gram approved in September 2003. It will The ADB-OECD initiative aims to If you have strong leadership, then people address graft and corruption in the finan- help build institutions and implement will follow,” says Mr. Stevens. cial markets, improve transparency, and anticorruption strategies without inter- More and more Asian governments strengthen investor protection. fering in internal corruption cases. It pro- are acknowledging that fighting graft Corruption distorts development by motes an integrated approach to and bribery is fundamental to the fight directing funds away from their intended policymaking while respecting country against poverty. Hong Kong, China, and purpose. Studies have shown that domes- differences, encourages partnerships be- Singapore—once among the most cor- tic investment, foreign investment, and tween governments and civil society, and rupt—turned around rapidly once the economic growth are lower in more corrupt promotes international aid coordination. political will emerged to do so. By using countries. While it may appear to “grease measures such as raising civil service sala- the wheels” for some, corruption only indi- Where Corruption Stands ries to levels that would discourage cor- cates the system has derailed. Acknowl- Corruption in parts of Asia is rampant. ruption—and with strong anticorruption edging and fighting it are central to Measuring corruption, however, is difficult bodies such as Hong Kong, China’s Inde- economic growth. „ due to the surrounding secrecy. pendent Commission Against Corrup- Serious study suggests, nonetheless, tion—corruption cleaned up. Singapore’s that it can be assessed, if not fully quanti- corruption watchdog is the Corrupt Prac- fied. To make it easier researchers use sur- tices Investigation Bureau. veys that gauge expert opinion, sometimes Abuse of power for personal benefit that of businesspeople. It is their percep- will likely always exist. Recent high-profile

tion that matters, because they will decide cases of corruption in Canada and the Richie Abrina where to invest their money in the region. United States show Transparency International, an interna- it is not just develop- “ tional nongovernment organization that ing countries that suf- Rampant corruption demonstrates brings civil society, business, and govern- fer from the problem, that the system is broken—resources are ments together to combat corruption, pro- nor is it culturally “not going where they should go vides respected assessments of corruption specific. around the world. Through its International “We won’t fool Michael Stevens, ADB Principal Audit Specialist Secretariat and more than 85 national chap- ourselves into think- ters, Transparency International works to ing we will get rid of it completely. It is raise awareness of the damaging effects of everywhere,” says Mr. Stevens. corruption, advocates policy reform, works The question becomes one of how to toward the implementation of multilat- work in a system where it is widespread, eral conventions, and monitors compliance and how to reduce it. s by governments, corporations, and banks. MDG Its last perceptions index ranked How ADB Deals with Corruption Singapore the fifth least corrupt country “People ask: why are you working with no- 1 Poverty and Hunger in its list of 133. Hong Kong, China, was toriously corrupt countries? By engaging 14th, and Malaysia 37th. Bangladesh was with a country and providing a loan or tech- 2 Education last, tailing Nigeria. nical assistance we have the opportunity Most Asian countries were in the bot- for policy dialogue and to bring the issue of 3 Gender Equality tom half of the index. corruption to the forefront of our discus- The need for measurement, however, sion and maintain dialogue on the issue,” 4 Child Mortality can be taken too far. “It does not matter says Mr. Jabes. what specific percent or level someone has ADB is helping countries set up corrup- 5 Maternal Health measured. The more important issue is tion watchdogs, such as in Bangladesh and whether there relatively is a little or a lot,” Indonesia. In Nepal, ADB assisted in set- 6 HIV/AIDS says Mr. Stevens. ting up the National Vigilance Center. In Malaysia, corruption foes are increas- Through a $600,000 technical assistance ingly hopeful the new Prime Minister, loan, the center is supporting the develop- 7 Environment Abdullah Ahmad Badawi, will keep his ment of technical auditing capacity within pledge to crack down on corruption. His the Government and the private sector, 8 Global Partnership

June 2004 9 LAW MATTERS MEETING THE

CHALLENGEThe Millennium Declaration calls for a joint effort by nations to refocus their priorities to achieve significant changes by 2015—it is a daunting task that presents many challenges

By Kamal Ahmad institutional arrangements and priorities at Counsel, Law and Policy Reform Unit, national and global levels. Office of the General Counsel New, Better Opportunities hen 147 countries be- To fulfill the Millennium Development came signatories to the Goals (MDGs), the poor must find new and TRAPPED Landless sharecroppers are Millennium Declara- better opportunities for their livelihoods. often caught in a vicious cycle that tion, they entered into Provision of basic social services, such as robs them of their liberty a social contract with health care, water and sanitation, and edu- Wone another—but the Declaration is no or- cation must also be expanded and im- vulnerability of its citizens, especially the dinary contract. Though not legally bind- proved. Economic growth must enable the poor, by using its monopoly over the security ing, it constitutes “soft law,” a moral impe- poor to engage in the process and benefit apparatus. It must guard against abuse of rative for the signatories to act on the prom- from it without devouring the natural re- power by state functionaries, and strengthen ises they made to help refocus global atten- source endowments on which the prospects law and order while making the police and tion, energy, and resources to reduce by of our future generations depend. judiciary more accountable. 2015—or, in some cases, 2020—the suffer- An effective legal framework for the ac- ADB is playing a role in this through, for ing of nearly 2 billion people who are affected countability of public institutions and a example, its assistance to Pakistan’s Access by malnutrition, disease, and premature capacity of citizens to assert their legal to Justice Program, which supports an in- death. Of course, grinding poverty has with- rights are minimum requirements for the crease in budgetary expenditure on the police stood the grand eloquence of past declara- sustainability of the MDGs. Public insti- and judiciary while seeking more transpar- tions. In 1974, for instance, Henry Kissinger, tutions must have the capacity to deliver ency in accountability of these institutions. then the United States’ Secretary of State, appropriate services and assist people in In 2000, an ADB-commissioned study famously declared that by 1984 no child, identifying their needs and priorities. examined how legal empowerment contrib- woman, or man would ever go to bed hungry. Poor governance, corruption, and lack of utes to good governance, poverty reduction, Three decades later, Kissinger’s promise re- accountability forestall development. Le- and other MDGs. It showed that legal em- mains grossly unfulfilled. At the same time gal and institutional reforms will help cre- powerment increases the ability of the poor history also demonstrates that when the ate conditions for active citizenship so the to play a more informed role in local deci- world has united in addressing a particular poor have access to information to enable sion making to advance their rights and scourge, it can succeed in eliminating it al- them to understand and secure their rights. interests. It also showed that the height- together as the cases of smallpox and polio By increasing accountability, public in- ened public interest and expectations that eradication show. stitutions will become more transparent in can result from legal empowerment can have The Declaration, while echoing past their operations, enabling citizens to un- a catalytic impact in goading public institu- promises and commitments, is unprece- derstand how resources are used and deci- tions to be more responsive and accountable dented in its nature, scope, and specificity. sions made, and providing clearer avenues to the needs and rights of the poor. Its eight objectives have measurable out- for grievance resolution. Active citizenship ADB studies have confirmed that gen- comes, time lines for achievements, and clear implies a legal framework that enables citi- der disparities are acute in Asia. Legal and indicators for monitoring progress. zens to effectively articulate their views. constitutional safeguards against discrimi- The Declaration calls for changes in nation, while not guaranteeing protection, the norms that govern societies: it calls for Guarding Against Abuse can be a significant first step toward reform. a fundamental reorientation of legal and The state must address insecurity and Already, India and Pakistan have set

10 June 2004 at certain quota volumes. Often the products affected are those over which low- and middle-income coun- tries have a comparative advantage, such as textiles. For example, Bangladesh’s main export is ready-made garments. The indus- try employs almost two million women for whom there are limited alternative liveli- hood opportunities. The tariff charged by the United States on Bangladesh’s $2 bil- lion of mostly textile exports is higher than the tariff charged to France for its $30 bil- lion of exports. An international trade re- gime supportive of the MDGs ought to eliminate such distortions of trade. While the MDGs are universal, no single approach is likely to be effective every- where. Each country must develop its own framework for catalyzing diverse local pro- cesses that will ultimately yield the best results. The MDGs call for global priorities to be aligned in a way that can dramatically reduce the deprivation suffered by poor people. However, the goals can only be achieved and sustained when the policies, Ram Cabrera laws, and institutions implicated in this ef- fort are also aligned to meet this challenge. While the MDGs are universal, no single Without such a holistic approach, risk exists approach is likely to be effective everywhere that targets set by the Millennium Declara- tion may be met without addressing the aside reserved seats for women in national land remains unregistered, rendering it structural issues that ultimately will deter- and local governments. Bangladesh is also unavailable as collateral for obtaining mine the durability of such success. Here contemplating reintroducing such a mea- credit. ADB has been collaborating with the the stakes are indeed high. „ sure for elections to the national parliament. Government of Cambodia to establish a Afghanistan’s new constitution envisages legal system with respect to landownership the reservation of seats for women. and land rights, including access to credit Most of Asia’s poor depend on agricul- by mortgaging land. ture for their livelihood. Access to land and ADB research has pioneered an inte- landownership is critical to the economic grated approach to insolvency and secured s empowerment of the rural poor. Without such transaction law reform to ensure that insol- MDG access, the rural poor have difficulty gaining vency reforms support secured lending and credit at reasonable terms. An example of contribute to a more predictable debtor- 1 Poverty and Hunger the consequences of this can be seen in the creditor legal regime. case of bonded laborers in Pakistan, in the While changes in a nation’s domestic 2 Education province of Sindh, where landless sharecrop- policies, laws, and institutional norms are pers are caught in a vicious cycle that robs crucial, changes in the global framework 3 Gender Equality them of their liberty. are also necessary. Trade and nontrade bar- riers, particularly concerning agricultural 4 Child Mortality Raising Awareness products, still challenge many developing ADB assistance to the Government of countries trying to break into the consumer 5 Maternal Health Pakistan through a loan for the Sindh Rural markets of high-income countries. Although Development Project is helping address tariff structures are often favorable to de- 6 HIV/AIDS the plight of bonded laborers by, among oth- veloping countries, particularly under pref- ers, raising legal awareness and indepen- erential access arrangements, such as the dent transaction monitoring of debts that Generalized System of Preferences and the 7 Environment ultimately forces a laborer into a bonded European Union’s Everything but Arms ini- state. In Cambodia, much of the nation’s tiative, tariffs for some products escalate 8 Global Partnership

June 2004 11 NUTRITION

By Lisa Studdert than 35% of women aged 15–49 are iron Rice to the Rescue Health Specialist deficient, and more than 500 die during To many researchers and health specia- pregnancy and childbirth each year as a lists, this has been a long dreamed of de- ron deficiency is the most common result, according to the United Nations velopment in fighting micronutrient of all nutritional deficiencies. It im- Children’s Fund (UNICEF) in 2004. deficiencies—and now ADB’s support to pairs the mental development of up For many years, governments and pub- a global effort to improve the nutrient qual- to 60% of children aged 6–24 months lic health nutrition specialists—from do- ity of rice is helping make this a reality. in the developing world. nor organizations to community health In collaboration with the International ISevere iron deficiency causes the deaths clinics—have struggled to find effective Food Policy Research Institute (IFPRI) of an estimated 50,000 women in preg- and sustainable ways to address this per- and the International Rice Research Insti- nancy and childbirth each year. It is esti- vasive problem. Iron tablets are a possible tute (IRRI), ADB has supported the work mated that in severely affected areas, the solution but require an ongoing supply and of plant breeders at IRRI to identify rice subsequent loss of productivity in the can cause uncomfortable (but harmless) crop varieties that have a naturally occur- workforce through iron deficiency may ac- side effects. ring high level of iron and to selectively count for a loss of up to 2% of gross domes- In the long term, ensuring adequate iron breed these to enhance that iron content tic product (GDP) in the worst-affected intake through food is seen as the best so- while also maintaining crop productivity countries. lution. In most populations, the best and consumer acceptance. The latter is Among ADB’s developing member sources of iron in the food supply are meat important to ensure that any newly devel- countries, an estimated 22,000 women die products, but these are relatively expen- oped varieties maintain farmers’ incomes; in India each year because of severe ane- sive and thus rarely consumed by the poor. otherwise, farmers cannot be expected to mia during childbirth. In Afghanistan, 65% But imagine if the rice so extensively adopt and grow the new varieties for the of children under the age of five are severely eaten by the poor across Asia was naturally benefit of consumers. iron deficient. In the Philippines, more bred and selected for high iron content. After screening more than 1,600 variet-

Trials to gauge the effectiveness of boosting the iron content of rice are showing encouraging results that could drastically decrease micronutrient deficiencies RICE POWER Lingkod Sayo/IRRI SUPPER FOR SCIENCE 300300 religiousreligious sisterssisters inin 11 convents around Manila are taking part inin aa trialtrial toto determinedetermine thethe healthhealth benefitsbenefits ofof a new strain of iron-enriched rice

12 June 2004 HEALTH ies, a new strain (IR68144) was developed POOR DIET In India that had an iron content of 10 parts per alone, an estimated million. This is approximately four to five 22,000 women die times more iron (after processing and cook- each year as a ing) than most varieties currently con- result of severe sumed in the Philippines. But does this anemia during translate into improved iron status in the childbirth consumer?

Clues in Convent Trial To test this, a trial was planned with more than 300 religious sisters in 11 convents around Manila. With her full agreement, each sister was randomly assigned to re- ceive either regular (low iron) rice or the new high-iron variety. The sisters and the research team were not told what they were receiving during the trial. The sisters rep- resented an ideal population for such a study because their food is cooked in a com- mon kitchen and consumed in a common dining room, so the distribution and con- sumption of different rice varieties can be carefully monitored. The sisters’ iron status as indicated by

hemoglobin and other biochemical indi- Matthew Westfall cators of iron status was measured before the trial began, halfway (4.5 months), and The same women who consumed the high-iron rice at the conclusion (9 months). Women on average also increased their body iron by 10% remaining—or newly—iron-deficient at the end of the trial were given iron supple- The next step is to conduct trials on ing the MDG Goal 4 on reducing child ments to ensure this deficiency was quickly the effect and use of high-iron rice in a com- mortality. For sustained, effective solu- corrected. munity setting and look at the effect on tions, a continuing, concerted effort is re- The trial concluded in September 2003 children’s iron status. A study is planned quired from a diverse range of people and, so far, the analysis of data indicate in Bangladesh in 2004–2005. including plant breeders, nutritionists, the results have been positive. Among the ADB’s involvement in this work started multidisciplinary research teams, donors, women who were iron-deficient but not yet in 2000 under the leadership of Joseph and affected communities. anemic at the start of the trial, total body Hunt, ADB Senior Health and Nutrition The prospect of helping children reach iron reserves improved significantly. The Specialist (now retired). Due to ADB’s their full intellectual potential and women who consumed the high-iron rice commitment to the concept of biofortified women survive the most basic and impor- ingested about 20% more iron per day than crops for improving the nutritional status tant process of childbirth makes this effort those who consumed the regular rice. The of the poor, there have been significant more than worthwhile. „ same women who consumed the high-iron developments in the field. rice on average also increased their body In October 2003, the Bill and Melinda iron by 10%, while the women consuming Gates Foundation committed $25 million control rice actually lost 6% of their body to IFPRI’s HarvestPlus program that will iron. The greatest increases in body iron work to develop crops with enhanced nu- were seen in the women who consumed the trient status: not just with iron but also s most iron from biofortified rice. with vitamin A and zinc and in other key MDG These are preliminary results and staple crops on which the poor around the 1 Poverty and Hunger analysis is ongoing . The research team is world depend (wheat, maize, beans, cas- preparing papers for submission to scien- sava, and sweet potato). 4 Child Mortality tific journals and results will be presented Improving iron status in Asia’s poor at conferences for discussion and delibera- populations will directly serve global ef- tion. Most importantly though—for ADB, forts to meet the Millennium Develop- 5 Maternal Health IFPRI, and IRRI—they indicate that there ment Goal (MDG) 5 on improving is good reason to keep pursuing this work. maternal health and contribute to achiev- 8 Global Partnership

June 2004 13 FAST GROWER Learning innovative ways Ma bamboo is to manage their environ- considered one of Yongchun County’s ment has created new six major industries opportunities for poor rural dwellers in Fujian Province in the People’s Republic of China

By KyeongAe Choe and Carolyn Dedolph Senior Project Specialist, and External Relations Specialist

very time it rained, the farm- ers of Shi Gu Town in Yongchun County, Fujian Prov- ince in the People’s Republic of China (PRC), would watch Ethe sandy soil—and their livelihoods— wash down the denuded hillsides. They had difficulty eking a living out of their sloping fields, which had suffered from years of poor cropping practices. In 1996, the average annual household income in the village was yuan (CNY) 1,800 ($220), with a third of the house- holds earning less than CNY1,000 ($120). However, a fast-growing variety of bamboo (Dendocalumus latiflorus) has changed their lives for the better. Known for its bountiful shoot production, Ma bamboo has nearly stopped the severe soil erosion and more than doubled farmers’ incomes. Ma bamboo, which grows to about 13 meters, has many uses: its young shoots can be eaten fresh or be canned, its stems are processed into incense sticks and bam- boo baskets, and its leaves are used as wrap- pers. By the third year, 15–20 kilograms (kg) of young shoots and 30 kg of poles may be harvested from every clump. “Bamboo is more profitable than other crops,” says farmer Gao Wen Xi as he cuts grass for green manure. Within two years of planting the bamboo, he was selling the shoots to a nearby canning facility and the stems (poles) to a local pulp mill. He has invested some of his earnings A TIME FOR from the bamboo into rice, pigs, and an or- ange orchard, increasing his family’s total income by CNY7,000–8,000 ($845–970) a year. He and his wife have also used the money to build a house and pay for their two children’s education. Carolyn Dedolph CHANGE 14 June 2004 RURAL DEVELOPMENT

Social Spin-Offs Income generated by the project exceeded Impressive Outcome About 27 million of Fujian Province’s 34 the expected income by 20% (CNY6,928 According to PRC official estimates, be- million people live in rural areas where the [$835] annually per family in 1995 con- tween 1998 and 2001 the soil conservation terrain ranges from mountainous to hilly to stant prices). Of the 64,000 or so partici- and agriculture development component of coastal. Arable land is limited, and what- pating rural households, 35% were below orchards, tea gardens, and bamboo planta- ever suitable land is available is intensively the poverty line in 1995; at completion, tions produced 40,000 tons of fruit, 8,000 cultivated, causing soil degradation and most had been lifted out of poverty. tons of tea, and 50,000 tons of bamboo shoots erosion. Since the start of economic reforms Local government support was impor- totaling CNY1,120 million ($135 million). in 1978, economic growth in Fujian has been tant in obtaining loans for private investors About 5,800 ha of new orchards were largely concentrated in urban areas, in- from local banks. A risk-sharing mechanism developed and 11,573 ha of existing or- creasing the rural-urban gap. among the village farmers engaged in chards rehabilitated (see story, p. 16). In the The Fujian Soil Conservation and Ru- orchard development with good perform- aquaculture component, about 90,000 tons ral Development Project, with a $65 mil- ing agro-business enterprises was one of the of aquatic products were produced worth lion loan from ADB and a $406,000 grant key factors for strong partnership and CNY1,200 million ($145 million) (see story, from the Japan Special Fund, began in 1995 success. Providing innovative small p. 17). Seven agro-processing facilities gen- and was completed in 2001. Its main shareholding opportunities and technical erated more than CNY80 million ($9.6 mil- objective was to promote sustainable and management support from private lion) in sales revenues and provided about growth in the rural economy in ways that business partners were also instrumental 700 permanent and 30,000 seasonal jobs. benefited the poorest people. in helping achieve the highly“ successful More than 19,000 training courses on con- outcome of tour terracing, fruit variety selection, soil the project. conservation, and orchard management Our goal is to serve the people and Risk sharing were conducted. alleviate poverty among our farmers through di- According to Fujian Vice-Governor Qiu rect parti- “ Lin Kai Wang, Project Director and Senior Agronomist Guang Zhong and provincial officials, the cipation, Fujian project was successful because it had The project’s five components were partnership, and government cooperation strong commitment from the Government linked by the common objective of promot- with the private sector in initiating rural to make it work and ensure the agriculture, ing soil conservation and rural develop- investments—and the eventual phaseout finance, and planning agencies worked to- ment. Farmers in degraded areas learned to of government interests in private enter- gether at all levels. The project was driven develop orchards using conservation- prise after the enterprise had fully devel- by the Agriculture Bureau, which had the effective measures; fishers in coastal areas oped—provided a strong foundation for staff and technical expertise to deliver new learned aquaculture techniques. mutual trust and confidence among private technologies and follow up with farmers. and public investors. “Our goal is to serve the people and The Right Choices alleviate poverty among our farmers,” says The soil and water conservation interven- Enterprise Reform Lin Kai Wang, Project Director and Senior tions focused on income-earning activities All the public enterprises involved under- Agronomist. Building on skills that were for the farmers, because experience showed went ownership restructuring, with govern- already available, the officials looked that activities linked to farm income would ment ownership gradually decreasing below closely at the markets and capacity to succeed. Farmers were encouraged to select 49%. The Vice Chairman of the Fujian Pro- repay the loan. They also made sure that the option best for their situation. vincial People’s Congress, Mr. Cao Degang, the investments were appropriately sized. Agro-processing industries and agricul- says that although it is the Government’s The success of the project was distin- ture market development linked agricul- job to provide an enabling environment for guished in yet another way: it was the first ture sector production activities with the people, the people themselves had ADB agriculture project to receive a highly processing and market distribution, pro- worked hard to achieve results. successful rating in the project completion moting a market cycle of primary produce Economic reforms encouraged the es- report. „ and off-farm employment opportunities. tablishment of the Rural Economic Coop- Small hydropower development provided erative, which allowed towns and villages the rural poor with electricity and a substi- to engage in productive economic activi- tute for firewood, subsequently protecting ties (collective farming, agro-processing, the forests as a measure of soil conserva- and rural industries) as a unit to collect s tion. The project area covers small water- and generate revenue. MDG sheds across 30 counties along the densely With the project creating the funding 1 Poverty and Hunger populated eastern coastline. necessary for change and developing an en- On average, real per capita household abling environment, the poor rural dwell- income almost doubled from CNY1,335 ers of Fujian Province have been able to turn 7 Environment ($290) (in 2003 current prices) before the their lives around, and make the most of project to CNY2,410 ($845) at completion. their harsh environment. 8 Global Partnership

June 2004 15 RURAL DEVELOPMENT

Struggle in Orchards In 1991, 40 farm households were encour- aged to develop the Heliukang Orchard by planting longan and other fruit trees on Carolyn Dedolph about 10 hectares (ha) of hilly, denuded land. But it was a struggle. Four years later, the farmers’ incomes were still low. Techniques to cultivate cash crops on sloping lands were not available. In 1996, the fruit farm was provided with a $410,505 loan through the Fujian Soil Conservation and Rural Development Project. The loan was used to support the Fujian Soil and Water Conservation Cen- ter in its work to disseminate appropriate technologies. An experienced fruit farm manager was elected to run the orchard, fast-grow- ing longan varieties were planted, and sci- entific principles implemented, such as applying green manure for fertilizer. Farm- ers also received individual loans. The farmers were trained in production and management technologies, with ex- perts giving lectures on fruit farming and soil conservation techniques. Full production started in 2001, with 2,400 trees in the Heliukang Orchard yield- ing an estimated 34 tons of longan valued at CNY202,250 ($24,450). Half the in- come goes to the farmers, and the rest is spent on operating the farm. With the trees Fruit now producing fruit, the farmers will start repaying their individual loans, typically at an annual rate of about CNY500 ($60). A New Budding Prosperity Farmers no longer need Although Chen Guo Hua never resorted to to sell their blood to send selling his blood, he is pleased with his larger income from the orchard and his other en- their children to school terprises: rice, watermelon, and pigs. “Be- Lifeline fore this was wasteland,” he says as he cuts By Carolyn Dedolph banned in 1997, many farmers were again grass to make organic manure. “The soil External Relations Specialist left with few livelihood options. would wash down the hills and hurt the Tu Xing was one of these blood-selling rice land.” ntil a few years ago, private villages. Of the 1,300 people who live there, Thanks to the orchard, the village is blood collectors in the People’s 100 or so sold blood to supplement their beginning to flourish. New houses are be- Republic of China would go meager farm income of about yuan (CNY) ing built, and farmers have been diversify- from one rural village to an- 500 ($60) per household in 1990. ing into other crops and livestock. By raising other—andU poor farmers would roll up their Farmer Chen Zong Yu would sell his funds through farmers’ donations to match sleeves. The blood collectors, however, blood twice a month to pay for his children’s government funds, a paved road is being spread more than money around the coun- education. The going price then was laid to the village from the highway. It will tryside during the 1980s and 1990s. CNY200 ($24) for 400cc. Fortunately, give residents year-round, all-weather access Because of their lax sanitary procedures, those days are gone forever. “Trees are a bet- to the main roads—and markets for their fruit unsuspecting donors were sometimes in- ter way to earn a living,” he says, referring and other produce. Most importantly, farm- fected with hepatitis, syphilis, HIV/AIDS, to his small plot of longan trees, which pro- ers have found a means to earn a living with- and other diseases. When blood selling was duce a small pulpy fruit similar to litchis. out having to sell their blood. „

16 June 2004 Seaweed: A Chilling Tale Cold storage brings more jobs for women, better prices for kelp, and new opportunities

By Carolyn Dedolph Simple Solution External Relations Specialist In 1995, the Guan Wu village committee built a simple salted kelp processing plant or as far as the eye can see, beds of and established the community-owned Richie Abrina lanky green kelp dot the sea in tidy Guan Wu Seafoods. In 1997, the company rows outside the village of An Kai received a yuan (CNY)7.3 million ($882,000) on the Huangqi Peninsula in loan from ADB through the Fujian Soil southeasternF People’s Republic of China Conservation and Rural Development (PRC). For ages, farmers here have pulled Project. Within a year, the community had kelp from the water in April and May and used the loan to build a cold storage facil- set it out in the sun to dry. Then they would ity that allows year-round kelp processing, hope it would not rain. With mildew and generating more employment opportunities rot typically claiming 20–30% of every har- and better market prices. vest, producers must sell the kelp as quickly The company has established a nursery as possible, typically at low prices. to produce kelp seedlings for the sea farm- Fisher Li Shao Xiong says he wishes for ers, and hatcheries have been built for high- better times for the people of An Kai: “If value seafood such as abalone, sea urchin, we had a kelp processing plant here, we grouper, flounder, and other rare fish. would get better prices and more women More than 900 households in Guan Wu would have jobs.” and adjacent villages are benefiting from About 50 kilometers away is the village the facility. Nearly all the households sell of Guan Wu where, until a few years ago, kelp, now at prices 25–30% more than be- nearly half of its people lived below the pov- fore. In the peak season, the facility pro- erty line. But a cold storage facility for kelp vides 700–800 jobs, mainly for women. Even PRODUCTION PUSH A kelp processing plant and cold storage facility in Guan Wu has dramatically changed life in Guan Wu. in the off-season, the factory provides 150– enables year-round processing, higher When Lin Zhe Long returned to his 200 employment opportunities. market prices, and more jobs home village in 1984 after serving in the “Life is much better now than before,” army, he saw Guan Wu’s situation all too says Mr. Lin proudly. roads, building sewage treatment facilities, clearly. “We were using very old techniques and planting trees. The community has for kelp culture. We needed new technolo- Rise in Consumerism also established a foundation that sponsors gies—otherwise our incomes would never In the past few years, the village commit- scholarships for young people to pursue ad- increase,” says Mr. Lin, who is now General tee used more than CNY1.5 million vanced studies. Manager of Guan Wu Seafoods Develop- ($181,000) from the company’s profits to “There is a Chinese saying, ‘Leave no ment Co. (Ltd). improve public welfare by constructing one behind.’ We want everyone in our vil- lage to prosper,” says General Manager Lin. His vision seems to be coming true. „ Carolyn Dedolph MDGs 1 Poverty and Hunger 6 HIV/AIDS 7 Environment WAYS OF OLD People in the village of An KaiKai follow traditional aquaculture practices 8 Global Partnership

June 2004 17 ADB BOOKSTORE

Disseminating information and sharing knowledge are two of the most effective tools ADB has for sustaining development. ADB publications inform, instruct, and inspire both members and partners in the pursuit of the Millennium Development Goals and of ADB’s vision of a region free fromNew poverty. Publications PACIFIC Asian Development Bank Annual Report 2003 Millennium Development Goals in the Pacific: With the strong support of ADB, the Asia and Pacific region Relevance and Progress has continued its progress toward achieving the Millennium Publication Stock No. 020303 Development Goals by 2015. Overall poverty rates in the At the Monterrey Conference region have fallen, and growth has continued. Many of ADB’s in March 2002, multilateral members have made investments in health and nutrition, development banks, including which have reduced maternal and child mortality rates and the ADB, reached a consensus lowered the incidence of communicable diseases. to relate their long-term strategic frameworks to the Asian Development Outlook Millennium Development ISSN 0117-0481 Goals and to examine how the Price: $36 (paperback) MDGs could be reflected in ADO 2004 asserts that the Asia and country strategies and Pacific region continued to be the programs. This report presents most dynamic region in the world ADB’s first steps in this direction in 2003, growing at 6.3%. Despite for its Pacific developing member uncertainties generated by the Iraq countries. conflict, high oil prices, SARS, and a slow recovery in major industrial Swimming Against the Tide? countries, the region’s developing An Assessment of the Private economies generally showed remark- Sector in the Pacific able resilience. Intraregional trade and ISBN 971-561-534-1 strong consumer demand will define Price: $10 (paperback) the outlook for developing Asia in A robust and vibrant private sector is 2004–2005. The ADO 2004 includes vital to the Pacific region’s long- a chapter on foreign direct investment term economic growth and im- in developing Asia. proved quality of life and is a necessary condition for sustained Greater Mekong Subregion Atlas poverty reduction. This publication Greater Mekong Subregion Atlas of the Environment identifies many issues facing the ISBN 971-561-499-X private sector in ADB’s Pacific Price: $40 (paperback) DMCs. $60 (hardback) The Greater Mekong Subregion Atlas While Stocks Last of the Environment champions the The Live Reef Food Fish Trade environment of a unique part of Asia, ISBN 971-561-498-1 an area straddled by rivers great and Price: $10 (paperback) small, with bountiful watersheds, This book provides scientific wetlands, and forests. The Atlas evidence for the need to curb and captures for the first time in one manage the capture of wild live reef volume maps, remote sensing food fish, and proposes ways to help images, and essential information entrepreneurs and fishers reform the on one of the most culturally, ethni- trade based on limiting fish capture cally, and above all, biologically and hatchery rearing the fish. diverse regions in the world.

For these and other publications, contact the Asian Development Bank Publications Unit (Office of External Relations) P.O. Box 789, 0980 Manila, Philippines; Fax: (632) 636-2648; E-mail: [email protected]

http://www.adb.org/Publications

18 June 2004 WEB WATCH

MDG Update: Now Online NEWS FOR NGOS Comprehensive web site features ADB’s MDG initiatives Workshop Explores NGO- Private Sector Partner- By Cathy P. Reyes-Angus access to resources and markets, address ships Against Poverty Assistant Web Administrator shared problems that stretch across Thirty representatives from NGOs, the borders, and avail of opportunities for private sector, governments, and bilat- he Millennium Development sharing knowledge and information. eral and multilateral development agen- Goals (MDGs) may be an ambi- • Assisting in mobilizing resources cies met in Thailand on 28–31 March tious agenda for reducing poverty effectivelyeffectively. In line with the emerging 2004, to discuss antipoverty partner- and improving lives, but ADB is global partnership agenda to support the ships between NGOs and the private Tsteadfast in its commitment to achieving MDGs, ADB will work closely with sector in Asia and the Pacific. The work- these goals at the regional and global levels. other development partners to comple- shop, sponsored by ADB in cooperation In October 2003, ADB launched its ment and build on one another’s with GlaxoSmithKline Biologicals and MDG web site. After extensive research, strengths. ADB is determined to play a the Population and Community Devel- the team led by Bruce Purdue, Head, and meaningful role in this emerging global opment Association, was organized to Josie Balane, Senior Results Management partnership. review case studies provided by partici- Officer, Results Management Unit, ADB • Conducting research and other pants, explore how donor organizations Strategy and Policy Department, developed policy analysesanalyses. ADB invests in gen- can facilitate partnerships, and consider a more in-depth web site that will help us- erating research and knowledge prod- options for future cooperation between ers understand how ADB assists its devel- ucts. These products are developed by NGOs and businesses. For more infor- oping member countries (DMCs) in many departments and offices, particu- mation, contact Grant Curtis at achieving the MDGs. larly the Economics and Research De- [email protected]. „ Dedicated to its vision of a region free partment, Regional and Sustainable of poverty, ADB strongly supports the MDGs Development Department, Regional ADB Builds NGO Capacity that define specific goals and targets for Economic Monitoring Unit, and ADB Staff of 20 NGOs from around Asia and measuring and monitoring progress toward Institute. the Pacific attended a training workshop poverty reduction. The site has information on more re- on participating in ADB-assisted activi- The web site highlights ADB’s MDG cent ADB research on the MDGs, and users ties, 16–19 March 2004. Hosted by the initiatives. can find out how ADB’s operational poli- International Institute of Rural • Mainstreaming MDGs in country cies and strategies relating to specific sec- Reconstruction in Cavite, Philippines, the strategy and programs. Consistent tors and themes enhance its contributions workshop improved understanding with ADB’s strategy, the MDGs are to the MDGs. among NGO representatives of how increasingly reflected in the country The web site also features Frequently ADB operates. The workshop was one strategy and program and poverty part- Asked Questions on the MDGs, latest news of several recent initiatives being un- nership agreement that ADB signs with and events, speeches and presentations dertaken to implement ADB-Govern- each DMC. by ADB Management and staff, and other ment-NGO Cooperation: A Framework • Building capacity to measure and related and useful links. for Action, 2003–2005. For more infor- monitor the MDGsMDGs. ADB is develop- Through the MDG site, ADB reaffirms mation, contact Suzanne Nazal at ing statistical databases on poverty and its support for achieving the eight goals. „ [email protected]. „ MDGs in the Asia and Pacific region, which are more detailed and compa- To learn more about the MDGs and ADB, visit Civil Society Consulted rable. Key Indicators of Developing Asia http://www.adb.org/MDGs/ and the Pacific has become one of ADB’s on ADF Replenishment main initiatives in monitoring and Negotiations on the next replenishment assessing the progress toward achiev- of the Asian Development Fund, ADF IX, ing the targets set under the MDGs have been under way since October in its DMCs. 2003. In January and February 2004, four • Helping achieve better results workshops were held to solicit the views through regional cooperationcooperation. Re- of civil society organizations (CSO) on gional cooperation is a core component policy issues. Selected CSO representa- of ADB’s strategy for reducing poverty tives met with donors during the Lisbon in the Asia and Pacific region. This re- round of negotiations in March 2004. flects the need to support the develop- For more information, contact Antonio ment of DMCs through cooperation to Ressano-Garcia at [email protected] or „ give more options by providing greater visit http://www.adb.org/adf/.

June 2004 19 EDUCATION

With decentralization putting the onus on education in Indonesia in the hands of district offices, schools, and communities, a project is aiming to turn this challenge into an opportunity

By Graham Dwyer External Relations Specialist

n Bali’s west coast, 3 hours from the tourist crowds of the island’s capital Den- pasar and popular beaches of Kuta, Nusa Dua, and Sanur,O is a hidden world of poverty that visi- tors rarely get to see. Jembrana, about 120 kilometers west of these tourist areas, is Bali’s poorest dis- trict, where poverty levels approach 40%. Yet, outwardly, it is deceptively picture perfect, as with much of the Indonesian island. Kilometers of well-paved roads lead past neatly manicured rural communities, picturesque Hindu shrines, and stunning BACK“We give the parents Rp60,000 ($7) Basic EducationTO for All BA rice terraces overshadowed by distant vol- for equipment and clothes,” explains Indonesia’s drive to provide universal basic canoes. Juminah, the school’s headmistress, 47. education, which covers nine years of But this is a district where unemploy- “Three days later, the parents are required primary and junior secondary schooling, ment and underemployment are high, wages to report back to us what they have bought— predates by more than six years the Mil- are low, and many people depend on casual bags, shoes, books, or uniforms.” lennium Development Goal (MDG) 2 of or seasonal labor, mostly in the fields and The village head, school committee, and achieving universal primary education by on fishing boats. Such work nets them the teachers get together to identify the most 2015. The country set an initial target of equivalent of little more than $1 per day— needy children at the junior school. So far, 2003. But as the economy reeled from the about the cost of a single drink in one of they have allocated scholarships to 12 chil- 1997 Asian financial crisis and political Kuta’s clubs. That leaves little for basic sub- dren of the 148-pupil school. turmoil, this was deferred to 2008. sistence, let alone health and education. But the scholarships are just one small According to ADB’s Key Indicators of De- One such laborer is Antiri, who is only part of a project, supported by an ADB loan veloping Asia and the Pacific 2003, Indonesia’s 32 but looks much older, her skin hardened of $100 million and a Government contri- net enrollment ratio in primary education by years of outdoor toil. “I am from a poor bution of $25 million that is also refur- fell from 95.4% in 1995 to 92.2% in 2000, family,” she says. “I have to work hard if I bishing the schools themselves. following three years of economic and po- want to put aside some money to pay for Approved in November 2001, the litical turmoil. The decline was similar to schooling of my children.” Decentralized Basic Education Project is that seen in other crisis-afflicted nations. One of her children, Susilo, 11, a stu- being undertaken over 7 years in Bali and At the same time, the country has been dent at Jembrana’s Negara 4 Junior Sec- the neighboring islands of Nusa Tenggara wrestling with decentralization. Effective ondary School, is receiving assistance under Barat, one of Indonesia’s poorest provinces January 2001, management and financing a scholarship supported by an ADB-funded with one of the lowest national enrollment of basic education were devolved to district Decentralized Basic Education Project in rates for provincial primary, junior, and governments. Basic education was previ- the province. secondary education. “ ously managed centrally through complex and compartmentalized structures in three ministries. The schools can now take charge of “The move from central control to de- education rather than be centrally planned centralization puts great responsibility on the planning, monitoring, and evaluation “ Cecile Gregory, ADB Principal Project Specialist on the district offices, schools, and com-

20 June 2004 explains Mr. Sugiana, the project manager is soon expecting new books provided by at the district education office. “This is the project. the first time block grants have been chan- In its first year, the physical improve- neled directly to schools for the school com- ments and school grants under the project Graham Dwyer (x2) mittee to manage,” he says. “We go to great are making a mark. Education officials say lengths to ensure transparency so that par- the dropout rate for basic education (age ents and the school committees know how 7–12) has dropped from 5% two years ago the money is being used.” to 0.02% in 2004, while the gross enroll- The schools post their accounts under ment rate has risen by 117% from less than the project on notice boards for all to in- 90% over the same period. spect and conduct outreach activities to But education remains an uphill ensure transparency. For example, headmis- struggle for the poor in Jembrana. “I am tress Juminah reaches those that cannot or thankful for the extra money, otherwise will not see the accounts by having the re- I would not be able to send my daughter to ports read out at local community meetings. school,” says fisherman Narka, whose 11- To ensure community participation in year-old daughter, Noviastini, receives the school’s rehabilitation, Mr. Sugiana says scholarship money at Negara 4 Junior Sec- that local skills are being harnessed, which ondary School. When asked what she wants BREAK TIME The children of Embang Kauh 2 also cuts the costs of the work. “Local com- to be when she grows up, Noviastini imme- Primary School, Jembrana munities have contributed through their diately says: “A doctor.” Her father cuts in, time and labor to help improve the condi- laughing: “I don’t have money for that.” tions of the school, and have also given Attaining such a level of education may money directly,” he adds. seem an insurmountable challenge to this father and child. But the message is getting Physical Repairs through that education makes good econo- In Jembrana, the project is slowly trans- mic sense for poor families, whose children forming some of the dingiest parts of the will have higher earning potential, even if BAmunitiesSICS themselves—and you have to schools from physical wrecks to being clean they may never fulfill all their dreams. And build capacity for that,” says Dedi Karyana, and functional. for headmistress Ms. Juminah, that pro- the project’s secretary in Indonesia’s Min- Cratered, dusty concrete floors in the vides a ray of hope. istry of National Education. classrooms have been replaced with new “I try to motivate parents and children The project is equipping the schools and white tiles, dirty scuffed walls have been and stress the importance of finishing districts to fully cope with the challenges— replastered, and dangerously worn bamboo school, as motivation to attend school has and opportunities—posed by decentraliza- thatched ceilings have been replaced. been low in this area,” she says. “Now they tion, explains Cecile Gregory, Principal One such school is Yeh Umbul 3 Pri- are beginning to respond. I hope that these Project Specialist and mission leader for the mary School in Mendoyo Subdistrict, where children in the future can now have a better project. “The schools can now take charge the headmaster Suama says, “The class- life than their parents.” „ of education rather than be centrally rooms here were in a critical condition. We planned. The project aims to help this pro- have repaired three out of five of them.” cess so that the children will stay longer Besides gleaming bright rooms, the project in school, achieve improved results, and is bringing electric lighting to the refur- have a curriculum that better serves their bished classrooms for the first time. needs,” she says. A few kilometers down the road, Since the academic year started in July Embang Kauh 2 Primary School is hoping 2003, the first funds from the project have for connection to the electric grid from coun- been disbursed to 783 schools in the two terpart funds in the next stage of the project. island provinces. About 1,000 more will re- An average of 40 children aged 7–11 are ceive funds in the next academic year. Apart crammed in each of the six dark classrooms, HEADING HOME A group of girls from the scholarships, these funds have been which get only limited natural light from used mostly for light to medium physical the neighboring paddy fields. “When the school repairs and quality improvement, in- weather is rainy and dark, we don’t ask the cluding the purchase of new books, reading students to study in these rooms, we try to aids, or training to upgrade the competence find some other activity for them to do,” of teachers. says headmaster Nurawa. As the schools prepare the plans them- The poor conditions are matched by the MDG selves, accountability to the local commu- state of the teaching aids. The students’ nity for every rupiah spent is crucial, books are ragged and overused. The school 2 Education

June 2004 21 LEADERSHIP

MEETING MATTERS Women elected Women trainers were chosen in the four as local representatives in Nepal project VDCs. A needs assessment was share information on how they can made and a training manual prepared. VDC be more effective in their roles chairs, vice chairs, ward chairpersons, and potential and existing elected women ward representatives received training. Thirty- six ward-level training sessions for women were held on the roles and responsibilities of the VDC and of elected women ward rep- resentatives, budget allocation per VDC, gender equity and development, women’s legal rights, leadership development, and crimes against women. Of the 129 women participants, nine trainers and one supervisor were selected in each of the workshops. Thirty-six train- ers and four supervisors across the four VDCs then learned to train women in their wards. Each trainer conducted nine two-day train- ing workshops over a three-month period. Fifteen women participated in each work-

Rollie del Rosario shop, resulting in the training of 1,215 women in each of the VDCs for a total of Deciding For Themselves 4,860 across the project. Eager for Change Women elected to local government are learning the Although affiliated with different politi- skills to participate fully in making decisions cal parties, the women were united in their views and aspirations and keen to develop By Judy Bryant Some women representatives have been their respective VDCs. Some said that be- Consultant Writer and Editor unaware of even the simplest information fore being elected, they had little interest regarding their responsibilities, such as in or awareness of local government. Now n March 1997 the King of Nepal is- that ward and VDCs should meet once a they were eager to play an active—and grow- sued an ordinance decreeing that 20% month. They also did not know that each ing—role in their wards. of local government seats be set aside VDC has its own development fund of One participant noted that women of- for women. Two months later, in NRs500,000 ($6,850), and that they, as fice bearers in her VDC had never met as a Nepal’sI local elections, more than 39,000 VDC representatives, have a right to help group before the project. After meeting with women assumed office for the first time for determine how this money is spent. SRISTI project leaders, she and other par- a five-year term. However, far from being a ticipants suggested that elected women triumph for the newly elected women, they Empowering Messages ward representatives convene before VDC quickly learned that their new title carried To empower the elected women ward rep- meetings to discuss their shared concerns little weight in the male-dominated vil- resentatives, ADB provided $20,000 for the and develop proposals. lage development committees (VDCs). effort in September 2000 to the Centre for The project demonstrated that expand- Though the Local Self-Governance Act Development and Population Activities, ing opportunities for women to participate of 1998 should have empowered elected the associate nongovernment organization in public forums while eliciting support women representatives, many remain un- of the Society for Research and Initiatives from their male counterparts is a workable aware of their roles and responsibilities, and for Sustainable Technologies and Institu- strategy to support the gender mainstream- are yet to fully exercise their rights in the tions (SRISTI). The project focused on ing process in local governance structures, VDC decision-making processes. training elected women ward representa- and that a better informed and aware com- Many elected women representatives tives and helping boost their confidence munity is more likely to demand transpar- still lack the information, confidence, and and capacity to participate in local gov- ency in prioritizing development projects. skills to participate fully in decision mak- ernment. The project was implemented in It is envisaged that this training should ing, and many face discrimination from four VDCs—one each in Lalitpur, take place in the first year of each elected their male counterparts. Many men in the Rupendehi, Dang, and Morang districts— woman ward representative’s five-year term VDCs believe that the elected women lack representing the central, western, so as to contribute to greater awareness of education and capacity, and only hold their midwestern, and eastern regions of Nepal, the roles and responsibilities of the VDC positions because of the mandate. respectively. and the women representatives. „

22 June 2004 ment guidelines for appraising, implement- ing, monitoring, and evaluating projects. Women Power It is hoped this will realize fully the provision of the Women in Development The Philippines is one of two Asian countries setting and Nation-Building Act mandating all overseas development assistance to allo- the standards in women leadership positions cate 5–30% of the resources to women and gender concerns. By Rita Festin In the private sector, 85% of Philip- ADB Media Officer pine companies have women in senior man- agement, according to newspaper reports ed by the country’s second woman citing Grant Thornton, a business advisory president, Gloria Macapagal- firm. It polled 6,900 medium-sized busi- Arroyo, women in power in the nesses from 26 major countries and territo- Philippines are more prominent ries in 2003 and found the Philippines Lnow than at anytime in the nation’s past. rated a close second to Russia, which has “Having more women in positions of almost 90%. power and decision making is a very impor- tant development,” says Emmeline Leading the Way Verzosa, Executive Director of the National The United Nations (UN) also cited the Commission on the Role of Filipino Women Philippines as one of two Asian countries (NCRFW), a policymaking body under the leading the way in having more women Office of the President. leadership positions. This is especially rel- “They can redefine national priorities evant at a time when most countries in and policies and place women’s concerns Asia are falling behind. Erna Witoelar, the

and experiences into the mainstream of Rita Festin UN’s Special Ambassador for Millen- politics,” she says. “This makes the goal of nium Development Goals, said the gender equality much more attainable.” Philippines and India enjoy a high pro- Of about 40 cabinet positions in the Having more women “ portion of women in their legislatures Philippine Government, 11 are currently in positions of power and and in local positions. held by women, the highest number of any “decision making is a very Elsewhere in Asia, women account administration. Legislation for women has for only 14.5% of lawmakers, according also been unprecedented. important development to Socorro Reyes, Senior Gender Adviser Emmeline Verzosa of the United Nations Development Executive Director, NCRFW Stronger Penalties Programme. She was quoted in news- The country now has one of the more pro- includes the “battered woman syndrome” papers as saying that despite laws and gressive laws against human trafficking as a justifying circumstance for self-defense, mechanisms in place, challenges remain with the Anti-Trafficking in Persons Act of leaving the woman-victim free from any and demands are daunting. Laws need to 2003, which criminalizes all forms of traf- civil or criminal liability if she injures or be enforced, monitored, and documented. ficking—with or without the consent of the kills her abuser. Women in postconflict areas also have spe- victim—for sex tourism purposes, prosti- The Philippines has been a model and cial needs that must be addressed. Aware- tution, mail-order brides, and pornography. pioneer in implementing a gender main- ness needs to be more widespread. It also imposes stiff penalties and provides streaming strategy in the bureaucracy. Gov- “Still, we remain optimistic that we are emergency shelter, legal, medical, and psy- ernment agencies are mandated to review on the right track. We believe that women chological services to victims. It also pe- their polices and programs, remove gender can meet the challenge of being a unifying nalizes customers of trafficked women in discriminatory practices, formulate and force for peace and good governance in this prostitution. implement a gender and development plan, critical stage when our country is driven by The Anti-Violence Against Women and and allocate at least 5% of their total bud- political divisions and conflicts,” adds their Children Act of 2004 criminalizes get for gender and development. Foreign- Ms. Verzosa. „ people who commit acts of physical, sexual, assisted projects are not spared from psychological (including verbal), and eco- checking their own gender biases. nomic abuse and violence against women The National Economic and Develop- and their children in a marriage, when dat- ment Authority, with the NCRFW, and the ing, or in a common-law relationship. For gender and development focal points the first time, a Philippine law protects of overseas development assistance agen- MDG women who are abused by their spouses, cies—including ADB—will soon release former partners, or lesbian partners. It also new harmonized gender and develop- 3 Gender Equality

June 2004 23 WOMEN Women in Bangladesh, Nepal, and Pakistan are overcoming discrimination and numerous obstacles LEARN to become leaders in their communities TO LEAD By Jet Damazo Nighat Afsar, for example, is a practic- were scared that we, the women, would be Consultant Public Relations Writer ing lawyer in Pakistan but she said she still a hurdle for them.” did not know what to do as district coun- After training and workshops, though, axmi Maharjan tried to stifle a cilor when she was first elected. they were able to resolve their problems. sniff as she described how it was At the start, women members of local The same is true in Bangladesh. growing up as a girl in Lalipur councils often just sat during meetings, Monjura Khanam, a member of the Union district in Nepal. “When I was unable to participate, because they were Parishad, said she spent the first four a child, I thought that to be not given instructions or ideas on what months of her term establishing a good Lborn as a girl was bad luck,” she told the their role was supposed to be. But through working relationship with her male coun- audience during a talk show, In the Spot- training provided by ADB under a regional terparts because she knew that they were light, held at ADB headquarters during technical assistance grant for gender and not comfortable with her. Women’s Week in March 2004. The talk governance, they learned of their roles and Even some older women, added Deepali show featured six women elected as local responsibilities, their powers, and the Chakoraborty, also a member of the Union government representatives in Bangladesh, resources they can access. Parishad, did not support them. “They tell Nepal, and Pakistan. “Now we are very aware of what we have us that the Union is not a place for us,” she Ms. Maharjan told of how discrimina- to do, and we are doing a lot in our commu- said. tion against women began at home. Boys nity,” said Ms. Afsar. DETERMINED were given better food and clothing, while Another Pakistani district councilor, Farzana Rauf, girls had to settle for leftovers. Boys were Farzana Rauf, from Jalipur district, had to Pakistani district sent to school, and girls were not. deal not only with lack of awareness of what councilor, took “I thought I didn’t have any fortune, she was supposed to do, but also with men an interest in which is why I was born a girl,” she said. who were not receptive to her presence in the budget and the council. negotiated with

More than Legal Limits the male Gender discrimination remains a serious Overcoming Fears councilors problem in their countries, where women “Not all of the men councilors were aware make up the majority of the poor. Their of the system,” she said. “They wanted to respective governments have tried to pass the budget without our approval. And “

address the problem by mandating that a when I took an interest in the budget, they Eric Sales (x2) percentage of local government seats be reserved for women, but legal limits are not the only barriers these women are up I had to prove myself in so many dimensions against. Bigger hurdles are educational and Bimala Basnet, member, Women’s Forum in Nepal sociocultural constraints. “ 24 June 2004 LEADERSHIP HEALTH

For Bimala Basnet, a member of the Women’s Forum in Nepal, the men—who HIV/AIDS Prevention likened the entry of women into the dis- trict/village council to a wild animal entering the community—were not the in Western Yunnan only problems. A novel approach of combining prevention programs Her family and friends were not sup- portive of her running for office. They tried and infrastructure projects is having impact to force her to resign after she was first By Eric Van Zant elected. Consultant Writer To earn her family’s support and the community’s respect, she worked hard in arge infrastructure projects, particularly major road construction, can contrib- her household while also attending to her ute substantially to the spread of HIV/AIDS. They can also create an opportu- responsibilities in the council. nity to spread knowledge about prevention of the disease. For that reason, ADB has begun to include prevention programs alongside its infrastructure projects.L In a unique move, ADB is imple- Proving Themselves “I had to prove myself in so many dimen- menting an HIV/AIDS prevention plan to sions—as a wife, as a mother, as a woman accompany the ADB-financed Western in the household and community, and as Yunnan Roads Development Project in the a leader,” she said. People’s Republic of China (PRC). Rollie del Rosario Despite all the difficulties they went “For the first time this approach was through, these women persevered and are implemented on a PRC road project and, REPERCUSSION Major roads can contribute now all respected members of their com- given the experience, I would strongly rec- to HIV/AIDS spread munity. Ms. Chakoraborty is involved in ommend that this be developed for all ma- her community’s primary education, road jor infrastructure projects,” says Jean-Marie Lacombe former officer in charge of PRC maintenance, and dispute resolution. road projects, and currently Head, Portfolio Management, Indonesia Resident Mission. Ms. Maharjan, who was thrown out of The expressway, to be implemented under the project, will improve transport her house by her parents when she ran between Kunming and Ruili, a town on the Myanmar border and at the epicenter of for office, campaigned for a citizenship the HIV epidemic in the PRC. certificate for women, and worked for a Anywhere between 15,000 and 20,000 workers will be employed each day dur- community census by registering deaths ing construction, which is due for completion around 2007. Typically young, the and marriages. workers are usually without their families and are often vulnerable to unsafe sex. Ms. Basnet, whose term in office has This leaves workers, the women drawn to the sites to work as prostitutes, and already expired, is honored in her commu- spouses at home vulnerable to HIV/AIDS. nity as a nadis, or judge. She says women The program offers an opportunity to systematically create awareness and help had been influenced to think that they protect people vulnerable to HIV/AIDS who would be otherwise difficult to reach. cannot be leaders. “Women are not aware In addition to the expressway component, the project will upgrade about of their own potential. Now that there are 300 kilometers of local roads in some of the poorest areas of Yunnan. good, respected leaders, other women want Financed from the Poverty Reduction Cooperation Fund through funds provided to be leaders like us.” by the United Kingdom’s Department for International Development, the program While a lot more remains to be done, will raise awareness on HIV/AIDS. It will promote safe-sex practices and use of condoms, they all feel that having women in govern- and ensure HIV/AIDS prevention services are offered at contractors’ work sites. ment is an important step. It will enhance the HIV/AIDS monitoring system, including the surveillance of the “I believe that if women participate epidemic in the region. in politics in the real sense, in decision In the past, dealing with problems like HIV/AIDS associated with major projects making, there will be no discriminatory would have been dealt with through a provision in the contract with civil works law at any level,” said Ms. Afsar. “I think contractors, says Mr. Lacombe. Designing and implementing a specific prevention empowering women is empowering a program concurrently is expected to be more effective. nation.” „ Mr. Lacombe says the experience, which involved concerted efforts to gain agree- ment from various PRC government departments, can be applied in other countries. Including disease prevention in the design of large projects is in keeping with MDG the ADB’s strategy for reducing poverty MDG and with the Millennium Development 3 Gender Equality Goals. „ 6 HIV/AIDS

June 2004 25 HEALTH

Battling ingrained and unhealthy lifestyles through community partnerships with the health establish- ment is helping lower maternal and infant mortality rates, and reduce disease levels in rural Indonesia

By Graham Dwyer into raising family sanitation and health External Relations Specialist standards in remote rural areas of five far- flung provinces of Indonesia—Bengkulu, or the ramshackle village of Jambi, Central and South Kalimantan, and Tajepan, deep in Indonesia’s North Sumatra. rural Central Kalimantan Prov- Approved in 1996 with a loan of ince, the mighty Kapuas River $45 million, the project has been working brings life and livelihood— in the villages to create partnerships be- Fas well as death and disease. tween families and the staff of the The tenant farmers and fisherfolk, liv- puskesmas, the vast network of local health ing in their simple wooden dwellings on centers. Together they have been trying to stilts along its banks, draw on the river for improve family health and nutrition, lower their income and sustenance. They use it maternal and infant mortality rates, reduce for washing clothes and dishes, bathing, disease levels, and raise life expectancy— and drinking. But it also serves as their toi- targets that today are also embraced in the let and waste dump. Millennium Development Goals (MDGs). “I am immune to any problems from “Through assistance such as this the river water,” declares Basrah, who lives project, ADB has been supporting the ba- with her family in a wooden shack atop sic priorities that have, subsequently, been the river. At the back of her house is a plat- formulated into the MDGs,” says Jacques form at the water’s edge where she collects Jeugmans, ADB Senior Social Sectors GOOD HEALTH BEGIN all her family’s drinking and washing wa- Specialist and original mission leader for mortality per 100,000 live births more ter. Just above is the makeshift toilet, a the project. than halved from 470 to 213. Despite a small opening below which flows the By the early 1990s, when the project narrowing gap, these figures are still high murky brown river waters. was being drawn up, Indonesia had made compared with Indonesia’s neighbors, such A weather-beaten and wizened 30 rapid progress in improving its health as the Philippines. something—she has no idea of her exact indicators. This trend continued through “Improving maternal and child health age—she has borne six children, the sec- the project period, despite economic and was the ultimate goal of the project,” says ond of whom died in infancy of diarrhea. political turmoil, and the fallout from grow- Sulistianto, the South Kalimantan Project But she does not make any connection ing decentralization. Coordinator. “The most important issue with her contaminated water source. According to ADB’s Key Indicators of has been to change the behavior of the com- “It was not the fault of the river water, Developing Asia and the Pacific 2003, munity and create ‘family-friendly health it was just the season for diarrhea—every- Indonesia’s infant deaths declined from centers’ that are more client oriented.” body had it,” she says. 46 per 1,000 live births in 1995 to 33 in Over the years, a combination of tra-

Changing such ingrained and un- 2001. Over the same period, maternal ditional beliefs and low-quality services healthy attitudes, which have a profound impact particularly on infant and child “ health, has been a slow process in rural areas where poverty, ignorance, and isola- The most important issue has been to change the tion form an unholy trinity against improv- behavior of the community and create ‘family-friendly ing family health and nutrition habits. “health centers’ that are more client oriented But an ADB-funded Family Health and Sulistianto, South Kalimantan Project Coordinator Nutrition Project has been making inroads

26 June 2004 had contributed to low use of health faci- lities. The project aimed to mobilize com- munity groups, comprising 10 groups of 10 people in each village, to identify their problems and take responsibility for addressing them.

Prioritizing Health Problems Under the project, village groups were set up to discuss and prioritize local health problems. “Among the issues that came up repeatedly were the need for clean water, which is more effective in the long term to fight diarrhea and skin diseases than drugs, and better nutrition,” Mr. Jeugmans adds. The role of the health center is to pro- vide medical advice and recommend solu- tions to the problems identified. Each family received a health card listing the priorities that had been established in their consultations with the local community. This gives a complete record of the family’s health status and basic needs. Another priority identified under the project was raising incomes. The project, using also the Government’s counterpart funds, thus set up small loans to create income-generating schemes for the mem- bers, including cattle raising, duck farm- ing, and savings and loan activities. Revolving funds were also made available NS AT HOME for members to upgrade their homes. Graham Dwyer (x3)

MDGs 4 Child Mortality 5 Maternal Health

June 2004 27 HEALTH

For example, in Kurau, in the Tanah SAFETY FIRST Prenatal checks Laut district of Pelaihari, South Kali- at Kuala Kapua’s Health mantan, the fund was used as seed money Center, Central Kalimantan to build family toilets. A small loan was Graham Dwyer given to two families. When they built their facility and repaid the loan, the repayment would provide funds and a model for the next families, and so on, in a chain. Now almost all families in the area have their own toilets. To spread the message on health and nutrition, especially to those in more inac- cessible areas, the health centers have resorted to varied means, including door- to-door outreach conducted by midwives (see story, p 29). Fahrinawati, a midwife handling

Haniljayam village about 3 kilometers from the Kurau health center, services about 30 women needing neonatal care or infor- mation about contraceptive options. “In “ the past, families came to the clinic only when they faced some serious illness,” she Among the issues that came up repeatedly were says. “Now we find it much more effective to go to the patients as part of our outreach. the need for clean water and better nutrition While such midwives play a key role in “ Jacques Jeugmans, ADB Senior Social Sectors Specialist maintaining personal contact with pa- tients, there are other means of conduct- prevention and promotion,” she says. which could continue the activities of the ing health campaigns. For example, Kurau “People need to know how to come to the Family Health and Nutrition Project. To health center broadcasts its own commu- health center. But more important is how continue support to the Government in nity radio shows each morning, offering a to prevent sickness in the first place.” improving nutrition and household food mix of entertainment and music inter- However, getting people to look for security, ADB last year approved $500,000 spersed with health messages on sanita- treatment from health professionals is only for a technical assistance grant that will tion and problem illnesses, such as malaria. half the battle. They need better services design an urban nutrition management In Pelaihari, staff visit schools where they once they get there. The project has trained model through a public-private partner- sing, hold drawing competitions and tra- health clinic staff to take more client- ship, in support of the first MDG of eradi- ditional performances, and even some- oriented approaches, working with the com- cating extreme poverty and hunger by times teach in the classrooms directly. munity health groups rather than imposing 2015. The health centers’ message on the the central Government’s health priorities. For many, the Family Health and Nu- importance of sanitation, clean water, and Still, as the case of Tajepan shows, trition Project, which closed at the end of a balanced diet that includes fruit and health behavior cannot be changed over- 2003, has already marked a revolution in vegetables—all of which have a particular night. “It will take years to see the full their approach to health, hygiene, and nu- impact on child and maternal health— impact of the project as it takes a long time trition. Asmail Idup, one of the group lead- is getting through in some areas. to alter people’s behavior,” says Manahan ers of the health membership scheme in Pangaribuan, the new head of health ser- Kurau, proudly shows off his new toilet and Helping Empower vices for South Kalimantan. “The chal- water faucet, provided under the project, “The project has helped empower the com- lenge is how to replicate the project in other at the back of his simple wooden dwelling. munity, making the people well informed districts, as funds are limited. “Before, we would just get water from and willing to access the health center,” “We have been persuading heads of dis- anywhere and so suffered frequent ill says R.A. Vivi Mariana, who has been work- tricts to provide counterpart funding,” he health,” he says. “The project has taught ing for four years as the doctor in charge says. “We will see later in the year if we us to use clean water and now we don’t have of the Pelaihari center as part of her gov- have been successful. We are also hoping any big health problems.” ernment requirement to be assigned to re- to find linkages with new and future ADB His wife, Samiah, adds: “The most im- mote areas for five years following medical health projects.” portant thing we have gained is knowledge training. ADB recently approved a Second De- about our health because, before, we didn’t “In the past, the focus was on curative centralized Health Services Project (cov- have that. Being healthy is more precious treatment. Now we do outreach work on ering South and Central Kalimantan), than gold.” „

28 June 2004 HEALTH Fighting Ignorance Traditional medicine women are key to promoting cleanliness and better health

n the war against malnutrition and dis- ease among Indonesia’s rural women and young children, the midwives are the frontline troops in a two-pronged campaignI against ignorance and traditional practices. For years, Indonesian women have depended largely on untrained traditional medicine women, known as dukun, for their maternity and child-rearing needs, some- times with disastrous consequences. “When people are sick, they often go to the traditional healers, the dukun,” says Dr. Taufiqurrahman, in charge of the Kurau health center. “For a case such as diarrhea, the dukun might administer herbs or just give water accompanied by a special prayer. Building on the belief that sickness is caused by bad spirits, some dukun will take a gulp full of water and spray it at the patient with their mouth.” Yet for many women having babies, the dukun provide an affordable, highly conve- nient, and seemingly more comprehensive service than midwives, who receive formal training following high school and are paid about $60–$90 per month. “Dukun are willing to wait for days for a baby to be delivered, while the midwife will CHANGING TIMES A young woman (left) come only when it is time for the birth,” CHANGING TIMES A young woman (left) receives contraceptive pills from the health says Ms. Fahrinawati, a midwife at Kurau. center; A midwife making her rounds (below) “Also, women are afraid to get stitches and

injections that the midwives might admin- Graham Dwyer (x2) ister. Plus the dukun are often willing to take

care of the baby once it is born and even People are so much

wash up after birth.” better informed about She said the quality of dukun has been improving, as they now receive training from “health and nutrition. Now“ local districts in three basics—cleanliness in there is more knowledge, the area where the delivery takes place, clean so it is easier to work in equipment, and clean hands. But some of the traditional nutritional the local community practices can be damaging to babies and Fahrinawati, a midwife at Kurau mothers. For instance, Ms. Fahrinawati says, dukun commonly instruct the mother to give that before ADB’s Family Health and Nutri- honey to the newborn baby in the belief it tion Project, a baby in her area died from will stimulate them to suck. “Sometimes, such chronic constipation. the babies are even prescribed crushed “But that would not happen now,” she MDGs banana to try to settle the stomachs,” she adds. “People are so much better informed says. “The result is a bloated stomach and about health and nutrition. Now there is 4 Child Mortality chronic constipation as the baby can’t di- more knowledge, so it is easier to work in gest the food.” Ms. Fahrinawati remembers the local community.” „ 5 Maternal Health

June 2004 29 HEALING CAMBODIA’S HEALTH CARE By Eric Van Zant Consultant Writer A new program is helping

ambodia’s poor, when they elevate Cambodia’s health get sick, can be more likely care service from disarray to flee public health care workers than to seek advice into a system the community or treatment. Many will self- Ctreat or call in traditional healers before can afford and trust showing up at government-run clinics. “I was afraid of injections. When I saw Under the contracting system, use of the health staff come to my village, I took public services has risen sharply, particu- my little baby with me and hid in the larly among the poor. At the same time, bushes behind the village,” relates one average out-of-pocket health costs plunged, mother in the Memut District of Kampong dropping by more than $30 per capita for Cham Province. the bottom half of the population in some At an average age of 57 years, Cambodi- project districts. ans die earlier than their Vietnamese or Thai neighbors, have more babies, die more High Price for Poor Health often from malaria, and are more likely to Poor health comes at a high price in Cam- die when giving birth according to the bodia. On average, Cambodians spend United Nations Development Programme. $33 per person each year to treat sickness, After 25 years of upheaval in the country, compared with government health expen- Cambodia’s health situation is among the diture of just $2 per person. They often pay world’s worst. ill-informed drug sellers, untrained healers,

A government program that contracts or freelancing government health workers Expenditure on private organizations to run and upgrade for help—and the expense often destroys public health services is helping change families, homes, and lives. health care is one of that. It offers a unique way to achieve quick “Expenditure on health care is one of “the main reasons results and underscores the importance of the main reasons people are pushed into people are pushed “ innovation in working toward the Millen- poverty—they have to sell off assets to nium Development Goals. pay for services,” says Indu Bhushan, Prin- into poverty—they The widespread success of the program, cipal Project Economist, ADB Mekong have to sell off assets started in 1998, has convinced officials Department. to pay for services to expand contracting from 5 to 10 of the The contracted clinics are often more Indu Bhushan country’s 76 districts. effective and offer treatment closer to ADB Principal The program is part of the Health home, which saves on transport. Project Economist Sector Support Project financed through By paying roughly $4 per person a year a $20 million loan from ADB. The loan is to contract health services, the government tion between ADB, government and, also helping construct and renovate health program can, in a short time, lift an enor- nongovernment organizations (NGOs) in centers and hospitals, and support disease- mous burden from thousands of the poorest designing projects. control campaigns against HIV/AIDS, people and provide more professional care. Villagers are responding. The same malaria, and other diseases. It underscores the importance of coopera- mother who used to hide in the bushes says,

30 June 2004 HEALTH

Better Clinics Financial Incentives NGOs entice people in need of care with Overall care improved for several reasons, clean clinics, professional and respectful says HealthNet International, one of the services, and successful treatment. They contracted NGOs. Of critical importance use enforceable contracts, financial incen- was an end to private practice among pub- tives, user fees, and achievable goals to lic workers. motivate staff. Cambodia’s time under the Salaries were so low in the government Khmer Rouge and the years of civil conflict clinics, at $10–$30 per month, that health that followed ravaged its health system. workers had to seek other income. Many New services had to be created from openly sold their services outside of the scratch, and development has been in health centers and could earn 10 times progress for just over a decade. more than their official salaries. Under the 1998 plan, contractors were Payment was raised to levels high chosen through competitive bidding to enough to get staff to dedicate 100% of manage health services in five districts. In their time to the public system. Doctors two, known as contracting-out areas, the and district managers settled for salaries contractor had full responsibility for deliv- from $120–$180 per month. ering services—including hiring, firing, set- “Existing district health managers have ting wages, and allocating resources. worked in an environment where it was Contracting-in, by contrast, provided unwise to make unpopular decisions. Many private-sector management within a pub- managers in charge are afraid to discipline lic sector setup. Contractors gave manage- staff as they fear dreadful repercussions,” ment support to civil service health staff says HealthNet.

Ram Cabrera (x3) and could not hire or fire, but could request An outsider is not hindered by long- transfers and receive a budget for incentives standing relationships with staff and man- MATERNAL INSTINCT and operating expenses. agers, and with reasonable incentives can Increased numbers Increased numbers All five districts improved service cov- get acceptance of new ideas. of pregnant woman erage in a short time, the strongest being “Civil servants expect life-long employ- are seeking care at Cambodia’s contracted the contracted-out districts. ment, and generally speaking, do not take clinics The use of health services among the risks that could jeopardize that position. poorest half of the population increased The contract manager (by contrast) knows by nearly 30 percentage points in the he has to score within the contract period,” contracted-out areas during the pilot pro- says HealthNet. Failure to perform could gram, as more and more people turned up mean no renewal. at the clinics. By boosting salaries and putting in One villager, Khun Srean, came to the financial incentives, NGOs are getting Memut Referral Hospital for delivery of her clinic staff to stop private practice and en- third child. “I prefer it because it costs less, sure quality of care. Efficient and cleaner the hospital is clean and close to my house, clinics are getting noticed, and patients are and the food and services are good.” abandoning often more expensive outside “One day my baby had a high fever. The In the expansion to 10 districts, how- treatment, and spreading the word. health worker in my village advised me to ever, it was decided after consultation be- Cambodia’s health care system remains bring him to a hospital in Memut. There tween ADB, NGOs, and the Government rudimentary. But by building new facili- they showed me the importance of immu- to use a hybrid system based mostly on the ties and contracting the management to nization and prevention of malaria. Now contracting-in model. private groups under ADB’s project, it is every month when the health worker or the Contracts with NGOs are still at a fixed improving. „ midwife calls, I always take my baby.” priced and based on performance, and the According to Save the Children Austra- contractor retains complete flexibility in lia, which was contracted in the Memut using whatever approaches and strategies district, “The wide level of community par- are deemed effective. ticipation has led to an overall increase in Contracting-out created friction with the number of patients seeking care and civil servants and politicians concerned s number of pregnant women receiving iron about losing control over health care. “The MDG supplements (currently 99%). All children Government was reluctant to expand the in our area now receive vitamin A supple- program, and so relinquished control of the 4 Child Mortality ments and have access to measles immu- health services. The results convinced nization.” them,” says Mr. Bhushan. 5 Maternal Health

June 2004 31 GETTING CONNECTED By Judy Bryant More than 70% of Phnom Penh Consultant Writer and Editor now has access to the city’s water distribution network pen a water faucet in Cambodia’s capital in 1993 and out would come little more than a trickle— if you were lucky. Phnom OPenh’s water supply and drainage systems were in disarray, having deteriorated over the years due to war, poor management, and lack of maintenance. Only 20% of the people in Phnom Penh had access to water supplied by the Phnom Penh Water Supply Authority (PPWSA). The organization’s staff of 500 was largely underqualified, underpaid, inefficient, and lacked motivation. Nepotism was rife, and morale and discipline among the workers were low. Upper management put its own needs before the interests of PPWSA, according to Ek Sonn Chan, the then newly installed PPWSA Director. The Government of Cambodia had given him the task of turning around an organization that was “in a sad state of chaos and disarray,” as he tells it. However, Mr. Chan had a vision of a PPWSA that was efficient, and well run— an organization where the workers prided themselves on the quality of their service delivery. To achieve this, hard decisions would mean job losses and tightening lax work habits, a harder line against corrup- tion, and installation of a new generation of managers.

Inefficiency Flushed Out In 1993 the people of Phnom Penh At the time, the number of PPWSA con- nections totaled 26,881, only 13% of which lacked a reliable water supply. After were metered, resulting in inaccurate and improper billing. a complete revamp of its main water In 1993 alone, 300 illegal connections supplier, all that has changed were discovered, and most of these had been installed by PPWSA staff for their own benefit. The going rate for an illegal con- nection was around $1,000. The PPWSA earned just riel (KR)0.7 billion ($175,400), against an operating cost of KR1.4 billion THIRST FOR ($350,900). What was needed, Mr. Chan says, was a change of culture—a complete restructur- ing of the organization, which would result in increased revenue while rehabilitating PPWSA’s distribution network and treat- ment plants. CHANGE Halsey Street In cleaning up PPWSA, Mr. Chan also 32 June 2004 WATER sought to support the Government’s efforts proved from 50% in 1993 to 99% in 2004. to supply clean and safe water directly to poor families. Building on Success Now, more than 10 years on, each of Because of its higher collection ratio, the 82,000 PPWSA connections in Phnom PPWSA has fully recovered its costs and is Penh is metered, and 70% of the city is con- now seeking to expand its network by aim- nected to the water distribution network. ing at 100% connection by 2005. Many factors contributed to the im- Challenges Ahead provement in the operations of PPWSA, says “Probably the most difficult of all,” says Xiaoyan Ye, Principal Project Specialist, Mr. Chan, “was to increase the water tariff ADB Mekong Department. “Political to cover its cost. The tariff was to be in- stability, strong government support, and creased in three steps over a seven-year external assistance from different devel- period. However, after the second increase opment agencies are but a few.”

in 2001, PPWSA found that its revenue But the most important factor comes Halsey Street already covered the cost of supply because from within the organiza- of the higher collection ratio, the drop tion itself, he says. “The in illegal connections, and reduction of success of this public water The poor often don’t get the water “ unaccounted-for water. enterprise is, to a large ex- PPWSA’s whole distribution network tent, the result of a cham- they need so desperately. This lack of was rehabilitated, with a repair team on pion of the cause in the “access to water has much to do with gover- standby 24 hours a day. The public re- person of Director Chan.” nance and the way water is managed sponded to encouragement by PPWSA to Mr. Chan’s leadership Tadao Chino, ADB President inform it of leaks, which were then quickly was recognized at ADB’s repaired. Water Week 2004 when PPWSA won the By 1996, with an ADB concessional loan ADB Water Prize 2004. The theme of Wa- of special drawing rights (SDR)13.7 mil- ter Week 2004 was “Water for the Poor— lion ($20 million equivalent), and funding Setting the Rules and Finding the Money,” from the World Bank and the governments and was designed to emphasize ADB’s fo- of France and Japan, PPWSA embarked on cus on the poor and its Water for All policy. renewing and rehabilitating its distribution Addressing Water Week 2004, ADB network, a task completed by 2002. New President Tadao Chino said, “The poor of- treatment plants were built and old ones ten don’t get the water they need so desper- rehabilitated. ately. This lack of access to water has much to do with governance and the way water is Leadership, Innovation managed.” PPWSA General Manager Ek Sonn Chan (right) receives the 2004 ADB Water Prize In restructuring PPWSA, Mr. Chan gave “The water crisis in our region is essen- from President Tadao Chino during the higher management more direct responsi- tially a crisis of governance,” Mr. Chino said. ADB Water Week in January bility. “Members of the more dynamic, Water Week 2004’s theme reinforced ADB’s Richie Abrina younger generation who possessed better commitment to the Millennium Develop- from over. According to Mr. Chan, PPWSA qualifications were promoted and given ment Goals, including the target of halving still faces two major challenges: sanitation more responsibilities,” he says. The num- the number of people without safe drinking and 100% connection. „ ber of PPWSA employees was reduced to water and sanitation by the year 2015. less than 400. The award recognized PPWSA’s leader- To read more about ADB’s water projects, go Salaries were increased, in some cases ship and innovation in project financing and to http://www.adb.org/water by up to 10 times, and performance-based good governance, consistent with and sup- bonuses were introduced. Those who per- portive of ADB’s Water for All policy, formed badly were penalized. Mr. Chino said. PPWSA started to install water meters With good leadership and improved gov- for all connections, and set up an inspec- ernance, Phnom Penh residents have a water s tion team to stop illegal connections. It re- supply 24 hours a day, in contrast to 10 hours MDG vised and improved its consumer files and in 1993. The city’s poor have better access 4 Child Mortality began to educate the public, especially to clean water through PPWSA’s improved high-ranking families, other government financial strength, which has enabled it to agencies, and even PPWSA top manage- expand services to poor areas where piped 5 Maternal Health ment, of the importance of paying their water supplies were once just a dream. water bills. The bill collection thus im- Despite these successes, the work is far 7 Environment

June 2004 33 FATAL ATTRACTION

An increase in mobility and worker migration in the Greater Mekong Subregion has coincided with a rapid rise in the rate of HIV/AIDS infection. Steps to counter the spread of the disease are showing results

By Eric Van Zant Yet, ironically, it is in these countries Consultant Writer that officials are coming to grips with the VICTIM An problem, and infection rates have stabi- AIDS patient and her hack-like brothels line the lized, or are slowing. medicine streets of the port city of “This is because of strong political com- Sihanoukville, in southern mitment, and a wide range of effective pre- Cambodia. In this hub mainly vention programs,” says Mr. Bhushan. for fishermen from neighbor- In Sihanoukville, as in the rest of Cam- Sing countries, dozens of young women aged bodia, all brothels have a policy of 100% 16 to 21 offer their bodies for as little as $2. condom use. Brothel workers are checked In Sihanoukville, new port facilities are weekly for signs of sexually transmitted being built with help from the Government diseases (STDs). of Japan, and while this growth attracts UNAIDS says the Cambodian Minis- more migrant workers, it also draws many try of Health recently estimated that with- young women who come to work in the out this intervention in the late 1990s, brothels with dreams of making money for HIV/AIDS infections would have been themselves and their families. Too often, three times higher than they are now. these young women leave not only with unfulfilled dreams, but also with HIV/ Mobile Infection

AIDS. More than 1,000 kilometers to the north- Ram Cabrera (x3) Cambodia, Myanmar, and Thailand are west of Cambodia, in Yunnan Province of at the center of an HIV/AIDS epidemic in the People’s Republic of China (PRC), and Cambodia, Myanmar, and the Greater Mekong Subregion (GMS). also in Myanmar, the spread of HIV/AIDS Thailand are at the center “Cambodia remains the biggest prob- is causing concern. of an HIV/AIDS epidemic lem now, with 2.6% of the adult popula- The city of Ruili in Yunnan Province, tion infected,” says Indu Bhushan, located on the old Burma Road bordering in the Greater Mekong Principal Project Economist, ADB Mekong Myanmar’s Shan State, is a major transit Subregion Department. route for booming regional trade.

34 June 2004 HEALTH

Truck drivers, traders, and traffickers HIV/AIDS first appeared in Yunnan Rapid Increase of contraband ply the route from Kunming Province in 1987, shortly after the first re- In 1999, about 420,000 people were in the PRC, to Mandalay in Myanmar, and ported cases in the PRC. By the early 1990s, known to be infected with HIV/AIDs in beyond. Many will rest at one of Ruili’s the epidemic was found mainly among in- South and Southeast Asia. That figure brothels where young women from the travenous drug users along the Myanmar- has increased to more than 5.6 million surrounding tribal hills work. Yunnan border. According to the PRC people in 2003. Population Services International, a Ministry of Health, the spread of HIV/AIDS “Thailand spends about $1 per capita nongovernment organization, says Ruili is increased at an annual average rate of 30% and Cambodia about 50 cents per capita a hub for intravenous drug users and sex until 2000. It rose 58% in 2001, and 17% on HIV/AIDS prevention and care. Viet workers from all over the PRC and in the first half of 2002. Nam spends less than 10 cents per capita Myanmar. It also says Ruili township has and Myanmar less than one cent,” says the PRC’s highest rate of HIV/AIDS No Time to Lose Mr. Bhushan. infection. In Myanmar, meanwhile, there is no time UNAIDS says crude estimates suggest Ruili is north of the Golden Triangle, to lose. The 2003 UNAIDS epidemic up- public and donor spending on HIV/AIDS the opium-producing area straddling north- date says intravenous drug use and com- prevention in 2003 probably did not exceed ern Thailand, Myanmar, and the Lao mercial sex are responsible for most HIV/ $200 million. To adequately fund preven- People’s Democratic Republic. AIDS infections. It says migrant workers, tion efforts the amount would need to rise especially gem to $2.2 billion in 2004 and $5.1 billion by URGENT More money is miners and loggers, 2007. needed for campaigns are becoming a Mr. Bhushan says that despite the ap- to educate people major conduit for parent stabilization in the rate of new HIV/ about HIV/AIDS the spread of the AIDs infections in Cambodia and Thailand, virus. the burden of HIV/AIDS-related illnesses “Among the will triple over the next 20 years unless three Asian coun- known prevention measures are backed tries hardest hit with funding. by the epidemic, He says ADB needs to do more. Among only in Myanmar its programs, an $8 million project sup- do national HIV ported by the Japan Fund for Poverty Re- infection rates con- duction to boost social marketing of tinue to rise,” says condoms in HIV/AIDS hot spots is enter- UNAIDS. ing its third and last year. ADB is also pro- “It remains to be moting a “Toolkit for HIV Prevention” among mobile populations in the GMS. Meeting the HIV/AIDS challenge is key to achieving Mr. Bhushan says a more comprehen- sive ADB policy would have three major the Millennium Development Goals focus points: an emphasis on policy dia- logue for public expenditure management ADB is participating in the Western seen whether Myanmar’s nascent preven- supporting HIV/AIDS during country pro- Yunnan Roads Development Project, which tion efforts will limit HIV prevalence to gramming; more effective integration of will improve access between Ruili and the 1–2% reported among 15–24-year-olds HIV/AIDS issues in infrastructure projects; Myanmar. However, with greater mobility in urban areas,” says UNAIDS. Overall, and more stand-alone support for HIV/ of people, including seasonal migrant work- urban adult prevalence (15–49 years old) AIDS prevention and care. ers, comes the risk of an increase in the speed was from 1.1% to 2.2% of the population Meeting the HIV/AIDS challenge is of transmission of HIV/AIDS. in 2002. key to achieving the Millennium Devel- Migration, mobility, and HIV/AIDS are In Cambodia and Thailand, the num- opment Goals. Goal 6 targets a halt in clearly interlinked, according to an ADB bers remain high, but HIV/AIDS prevalence the spread of HIV/AIDS by 2015 and the document. “High rates of HIV infection are has been checked by promoting greater con- beginning of a reversal trend. generally found along transport routes, in dom use in the commercial sex industry. Much remains to be done. „ border areas, and in regions experiencing In 2001, 670,000 people were known higher seasonal mobility.” to be infected with HIV/AIDS in Thai- To help counter this, ADB is imple- land. In Cambodia, 170,000 were known menting an HIV/AIDS prevention program to be infected, and the infection rate has alongside the road project, a unique move slowed to 2.6% in 2002, from 4% two that project officers say can be applied to years before. In Viet Nam, 130,000 MDG other infrastructure projects in other coun- people were known to be infected with tries (see story, p. 25). HIV/AIDS in 2001. 6 HIV/AIDS

June 2004 35 SNAPSHOT Ram Cabrera ACHIEVABLE? The Asian Development Bank takes pride in its role in helping its developing member countries—and the entire region—achieve the Millennium Development Goals. But meeting them by 2015 will be a challenge, with many countries poten- tially falling short of achieving some or all of the targets. ADB is committed to creating an environment for achieving the MDGs, a shared responsibility of all development stakeholders. This issue of ADB Review highlights MDG issues and provides examples of innovative projects that are eradicating extreme poverty and hunger, strengthening primary education, promoting gender equality, improving health, fighting HIV/AIDS, protecting the environment, and promoting partnership. ADB ONLINE Publisher: Robert Salamon Content Editor: Laurence Pochard http://www.adb.org Managing Editor and Layout Artist: Carolyn Dedolph Editor: Judy Bryant „ To read ADB Review online, go to Assistant Editors: Marcia R. Samson, Chona Murakami http://www.adb.org/review Designer: Ram Cabrera Graphic Assistant: Keech Hidalgo „ For information, send an e-mail Photo Researcher: Tess Perez to [email protected] or go to Advisors: Ann Quon, Ian Gill http://www.adb.org Distribution: ADB Publications Unit „ To explore business opportunities Fulfillment: ADB Printing Unit with ADB, go to http://www.adb.org/ ADB Review reports on development news from Asia and the Pacific and on the activities business/opportunities of the Asian Development Bank, which publishes the magazine six times a year. Opinions and materials in ADB Review do not necessarily reflect the official views of ADB. Materials „ For publications, go to http:// may be reprinted with credit given to ADB Review. Comments may be www.adb.org/publications sent by e-mail to [email protected]. For a free subscription, contact „ For the latest news, go to ADB Review, Office of External Relations, Asian Development Bank, http://www.adb.org/media P.O. Box 789, 0980 Manila, Philippines; or send an e-mail to [email protected] or fax a message to (632) 636-2648. ISSN: 0118-8674 36 June 2004