Category Archives: Global Health

A Sick South Asia: The price of Corruption

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Forget stock markets and GDP trends; there’s another annual report that genuinely reveals the health of a nation: Transparency International’s Corruption Perception Index (CPI). This year, the news for South Asia isn’t pretty. While the numbers don’t directly measure coughs or broken bones, they paint a chilling picture of a region struggling with a disease that eats away at its very well-being – corruption.

Across the board, South Asia scores below the global average, like a student consistently failing basic integrity tests. Only Bhutan and Maldives show signs of improvement, but what about the rest? Stagnant or slipping backwards. Afghanistan languishes at the bottom, Sri Lanka takes a worrying dip, and even giants like India and Pakistan fail to impress.

But why should we care about greased palms and shady deals when discussing health? Because corruption is a silent killer. It diverts lifesaving funds from hospitals, fuels the spread of counterfeit drugs, and silences voices that could expose public health failures. The lower the CPI score, the harder it becomes to guarantee equal access to quality healthcare, a fundamental human right that shouldn’t be a luxury. The CPI is a wake-up call that the fight for a healthier South Asia starts with tackling the rot at its core.

Consider how public health budgets for lifesaving medications and equipment are diverted to enrich corrupt individuals, a harsh reality in many South Asian countries. In 2022, Pakistan’s Anti-Corruption Establishment (ACE) registered a Rs 800 million embezzlement case against seven doctors and four other officials of the Mayo Hospital for a nefarious scheme, purchasing substandard items at inflated prices, effectively playing with people’s lives.

Meanwhile, a few days ago, in India, the Central Bureau of Investigation (CBI) arrested two of its own officers investigating alleged irregularities in Madhya Pradesh nursing colleges. These officers are accused of setting up a cartel that would collect bribes from college officials in exchange for overlooking issues and granting clean chits. The fake nursing college scandal in Madhya Pradesh, India, undermines public health by potentially graduating unqualified nurses who could put patients at risk, raising concerns about the broader prevalence of such institutions nationwide.

When COVID-19 first arrived in adjacent Bangladesh, doctors worried about the inadequate quality of personal protective equipment. There have also been instances of healthcare establishments providing fraudulent COVID-19 test results at a hefty cost. They went even further, charging a premium for Covid-19 treatment, which the hospital should have provided for free and reimbursed by the government. Instead, it did both.

Transparency International’s 2020 report on Pakistan paints a grim picture, highlighting the widespread practice of bribery for essential services like prenatal care and surgery. In this environment, the poor and marginalized, who are already struggling to make ends meet, are often left with no choice but to forego treatment, perpetuating a vicious cycle of illness and despair.

The Criminal Investigations Department (CID) arrested Sri Lanka’s former health minister and current environment minister in February 2024 for spending $465,00 on lifesaving medications that failed quality tests. Sri Lanka’s National Medicines Regulatory Authority (NMRA) claimed that falsified paperwork was utilized to get this batch of low-quality human immunoglobin, a lifesaving treatment for severe antibody deficiency. In the middle of last year, hospitals complained about patients’ drug reactions.

The ‘Pradhan Mantri Jan Arogya Yojana’ health insurance scheme, a source of hope for India’s low-income families, was rocked by allegations in 2021. Private hospitals entrusted with critical care have been accused of inflating bills, performing unnecessary surgeries, and even refusing to treat those who are eligible. This breach of trust may have diverted significant funds to provide a lifeline for the underprivileged. While investigations continue, the possibility of large-scale corruption casts a cloud of suspicion over this critical program.

Nepal’s Omni scandal during COVID-19 starkly illustrates the insidious reach of corruption in South Asian healthcare. Amidst the pandemic’s urgency, a dubious contract inflated prices and awarded medical supply procurement to a politically connected company (OBCI) lacking relevant experience. This case exposes the nexus between politics, business, and bureaucrats, where public health takes a backseat to self-interest, jeopardizing lives during a crisis.

Looking beyond our immediate borders, the Maldives, despite its idyllic image, is not immune to healthcare corruption. A 2019 Transparency Maldives report found evidence of bribery in procuring medical equipment and pharmaceuticals, raising concerns about the quality and accessibility of care. Similarly, Myanmar faces significant challenges. A United Nations report in 2021 highlighted inadequate healthcare infrastructure and a shortage of qualified personnel, exacerbated by potential systemic corruption.

In Ghana, over 80 children tragically lost their lives after consuming cough syrup imported from India, a grim result of systemic regulatory failures and corruption. This incident underscores the severe consequences of compromised safety standards in pharmaceutical exports, driven by the prioritization of profit over human lives. The Ghana scandal highlights the global ramifications of health sector corruption, demonstrating that lapses in regulatory oversight can have deadly international repercussions.

This discussion paints a bleak picture of how deeply corruption pervades South Asia’s health systems, with disastrous consequences for public health. This begs the question: can we remain silent in the face of such widespread suffering? Given the lacklustre and haphazard efforts of governments in this region to address corruption in meaningful ways, two key actors have a moral obligation to raise their voices and help tackle this issue head-on: WHO and UN agencies.

As the world’s leading authority on public health, the World Health Organization (WHO) cannot ignore the insidious link between corruption and poor health outcomes. Its regional and country offices must become vocal supporters of clean and transparent healthcare systems. Issuing strong statements is a powerful way to effect change. The WHO Director-General and regional directors should publicly condemn corruption in health, emphasizing its negative impact on populations. They can set the tone for prioritizing integrity and accountability in healthcare systems by stating their position clearly. Since WHO leadership now makes statements on ongoing wars and conflicts, corruption should no longer be taboo.

WHO’s ambivalence on corruption and reluctance to highlight how privatization of health services harms public health outcomes has not helped either. The evidence for this correlation has long been available, but there has been no effective advocacy by the global custodian of health. South Asian lawmakers and their families frequently own private hospitals, medical colleges, nursing homes, and schools. It is clear where they would stand in the privatization of health debate. WHO should advocate, in particular, with those international finance institutions constantly pushing for lower public-sector health spending and see privatization as the first line of treatment for failing healthcare systems.WHO enters into three to five-year country cooperation agreements with host governments to outline the agreed-upon work plan. Corruption in the healthcare sector should be a vital component of this agreement with allocated funds. Without this, the WHO becomes an accomplice to local politicians who steal donated money.

Thorough country-focused research and reports showing the quantifiable effects of corruption on health outcomes are another essential strategy for fighting health corruption. Data encourages decision-makers to act, especially when it comes to citizen health. Rather than adding to its already overburdened issue list, the WHO should work closely with organizations like Transparency International and the Boston University School of Public Health, which have specialized expertise and credibility in this field. In such partnerships, the WHOcan help develop clear policies, implement effective oversight mechanisms, and promote transparency in health procurement and resource allocation.

Supporting whistleblower protection within WHO, specifically its regional and country offices worldwide, is a critical aspect of combating corruption in health. WHO employees and collaborators who witness corruption firsthand should have safe and confidential channels to report it without fear of retaliation. The WHO can help expose corruption, hold wrongdoers accountable, and improve healthcare delivery by creating an environment where whistleblowers feel empowered and protected.

Development agencies, the United Nations, and international donors are critical players because they provide the financial and technical support required to drive country-level development efforts. However, due to the pervasive influence of corruption, these organizations frequently face obstacles in their efforts. To effectively address this issue, they must take proactive measures and make more intentional decisions. First, they should include corruption assessments in their country reports. This allows them to understand better the scope and nature of corruption in each country, which is critical when developing effective anti-corruption strategies. Recent UN country reports rarely mention the words “corruption” and “misgovernance.” Second, donors should tie aid to demonstrable anti-corruption efforts. Third, they should help civil society organizations (CSOs) combat corruption. CSOs play an essential role in holding governments and other institutions accountable, and they require financial and technical resources to do so effectively.

Corruption is a human invention; it can be dealt with, even in South Asia!

Published in print on 05 June 2024  in The Annapurna Express

Dr Sunoor Verma is the President of The Himalayan Dialogues and an international leadership communication expert. More on www.sunoor.net

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#Afghanistan #Bhutan #Bangladesh #Maldives #Myanmar #Nepal #Pakistan #SriLanka #India #Corruption #Health #WHO #UN #South Asia #Transparency #GobalHealth #GlobalHealthDiplomacy

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“You? A Man?” – A Conversation on Menopause in Kathmandu

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menopause nepal kathmandu sunoor verma sexual reproductive rights sex education

Picture courtesy Australian Embassy Nepal

Here I was, walking into the meeting hall for the Australian Embassy Kathmandu‘s “Menopause to Meno-peak” seminar, when I bumped into an acquaintance. Her greeting was as blunt as it was good-natured: “You? A man? On a menopause panel?” A fantastic start, I thought, for the lone male panelist on an all-star female team, especially considering the topic!

Truth be told, from the moment I accepted Ambassador Felicity Volk‘s invitation, I felt a similar sense of exhilaration (and maybe a touch of panic) as when you score a last-minute business class upgrade at check-in, only to realize you’re in your shorts and flip-flops!

Menopause, dialogue and engagement of boys and men on female sexual reproductive health. Gender equity. Nepal Sunoor Verma

Picture courtesy Australian Embassy Nepal

 

But any initial awkwardness melted away when I met my co-panelists. Ani Choying Drolma, the world-famous Buddhist Singing Nun, and Allie Pepper , the mountaineer who conquers peaks without supplemental oxygen to raise awareness about menopause and inspire women. These were powerhouse women, and I was about to embark on a truly unique conversation.

The audience was just as inspiring—a diverse mix of activists, policymakers, politicians, lawyers, health experts, and media of all ages and genders. Their questions during the Q&A session were as sharp as they were insightful, sparking a truly dynamic exchange.

Menopause, dialogue and engagement of boys and men on female sexual reproductive health. Gender equity. Nepal Sunoor VermaAni Choying Drolma on her journey and menopause. Picture courtesy Australian Embassy Nepal 

 

One particularly powerful moment came when Ani Choying Drolma shared her experiences with menopause. In many countries, faith and sexual and reproductive health are seen as opposing concepts. Ani’s courage in speaking openly highlighted the critical need for bridges between these areas. Her talk was a call to action, paving the way for partnerships to empower women on a deeper level.

Menopause, dialogue and engagement of boys and men on female sexual reproductive health. Gender equity. Nepal Sunoor VermaHE Ambassador Felicity Volk, host of this brave discussion. Picture courtesy Australian Embassy Nepal

 

Ambassador Felicity Volk‘s point about integrating #menopause knowledge into existing medical practices resonated deeply in her welcome remarks. We don’t need a whole new breed of specialists but a broader understanding among all health practitioners.

Being the only man on the panel also brought a dose of self-reflection. When the ace moderator Neeti Aryal Khanal, PhD asked how I felt, I confessed to feeling hyper-aware of #mansplaining, #manspreading, and all the other “man” faux pas! It gave me a heightened sense of being on the margins, similar to how many women might feel navigating traditionally male-dominated spaces, especially discussion panels.

Menopause, dialogue and engagement of boys and men on female sexual reproductive health. Gender equity. Nepal Sunoor VermaDon’t give up on us, men. Sunoor Verma responding to audience questions. Picture courtesy Australian Embassy Nepal

 

The complexities of menopause and Nepal’s unique socio-economic context led to some interesting discussions about potential solutions. When invited to share my thoughts, here is what I offered at different levels on the way forward. Some short-term and some more long-term:

Men: We need to listen and engage with women actively. Stepping outside our comfort zones and initiating conversations is a crucial first step. Don’t only listen but take notes.

Businesses: Make menopause resources readily available to your staff. Consider forming a health group that openly discusses both male and female sexual and reproductive health matters.

SRH (Sexual & Reproductive Health) Organizations: Rethink your strategies. Can we truly expect men to support women’s health if their own needs are neglected? Engaging them is essential.

Donors and Diplomats: Link aid to recipient countries to measurable improvements in women’s health indicators—a powerful measure of societal progress.

Women: Don’t give up on men! We may learn slower, but when engaged through the lens of our own health and family well-being, we often “get it” eventually.

This experience in #Kathmandu adds another chapter to a unique journey – being the only male speaker on all-female panels focused on women’s education, climate change and health in Geneva, Kigali, and now Kathmandu, respectively. Thank you to the Australian Embassy Kathmandu, Graduate Women International, and Observer Research Foundation for these incredible opportunities!

 

Published on LinkedIn on 04 June 2024

#Menopause #WomensHealth #WorkforceEquality #Kathmandu #AustraliaInNepal #Menstruation

Happy Arch of the Aorta Day!

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In the wake of the COVID-19 pandemic, we witnessed an unprecedented surge in health communication efforts aimed at educating and mobilizing the public. While the importance of such #healthcommunication cannot be understated, there’s a growing concern of “health communication fatigue” as we risk overloading the public with information. In this article, I will explore the challenges of communication fatigue and offer strategies to ensure our messages effectively achieve public health objectives.

Much like the indiscriminate use of antibiotics can lead to unintended consequences, over-communicating health messages without a strategic approach can render our communication efforts ineffective. In the early days of the pandemic, organizations like WHO took centre stage in effectively communicating complex scientific knowledge. However, as we’ve continued to flood the public with information, we now risk a “HelDemic” of excessive health communication, both digitally and physically. The very “Infodemic” many health organizations aim to fight may be gaining from the indiscriminate health communication these organizations are indulging in.

Indeed, it’s time to address the ever-expanding plethora of health days. We’ve come a long way from marking general health awareness days, and it seems like we’re on the brink of celebrating the “World Day of the Right Kidney” or perhaps the “Day of the Arch of the Aorta.” While raising awareness about specific diseases, organs, and behaviours is crucial, we must strike a balance. The constant barrage of dedicated days can dilute the impact and lead to a sense of exhaustion among the public. We must prioritize key health issues, combining awareness with concrete actions. Let’s not forget that meaningful change in public health is more about sustainable, well-thought-out strategies than having a day for every tiny medical detail. After all, there’s only so much room on the calendar, and we should use it wisely to ensure our messages hit home effectively.

#BehaviouralScience offers compelling insights into #MessageFatigue resulting from overcommunication. The human brain is inherently wired to adapt and filter information to efficiently process an overload of stimuli. When individuals are consistently bombarded with health messages and information, their attention span wanes, and their receptivity to new messages diminishes. This concept is known as habituation, a fundamental principle in psychology. When people encounter the same information repeatedly without novelty or a clear call to action, they become desensitized, rendering subsequent messages less effective. Additionally, cognitive load theory highlights that excessive information can overwhelm the brain’s limited mental resources, decreasing message retention and comprehension. To combat #messagefatigue, it is essential to apply behavioural science principles, such as novelty, relevance, and clarity, in health communication strategies, ensuring that messages are frequent, engaging, resonant, and actionable.

The primary challenge is balancing the need for information dissemination and the risk of communication fatigue. To do this effectively, we must prioritize and strategically choose critical health days for communication. Rather than inundating the public with continuous events and messages, we should focus on a select few that have the most significant impact in the context of each country’s morbidity and mortality data.

Similarly, before choosing the health day to mark and encourage the population to take action, check if you have created the necessary infrastructure and trained the health staff. Only talking and having no facilities supporting action will reduce the audience’s trust in you as a communicator. Let’s take a page from the Singaporean playbook, a country celebrated for its strategic approach to health campaigns. Unlike the chaotic flurry of information that can overwhelm public health communication efforts, Singapore opts for a more measured strategy. They first build the necessary infrastructure, invest in training their healthcare staff, and only then launch well-thought-out health campaigns. This method ensures that the communication aligns with the country’s capabilities and resources. For instance, their successful ‘War on Diabetes’ campaign was launched after setting up a nationwide system for diabetes prevention, care, and treatment. It’s a testament to how governments can measure health communication, focusing on sustainable actions over flashy announcements.

For low-income countries heavily reliant on foreign aid, public officials may focus excessively on marking health days prioritized by donors. This diverts their attention from core responsibilities and risks undermining domestic ownership and sustainability. Striking the right balance is essential and requires local health leadership to have a spine and be incorruptible.

A shining example of this approach is the nation of #Rwanda, which, after experiencing a devastating genocide in 1994, has risen like a phoenix, demonstrating the power of local stewardship. The Rwandan government has taken control of its #DevelopmentAgenda and #HealthCommunication strategies, ensuring that international donors align with their priorities. As a result, they’ve seen remarkable improvements in healthcare access, education, and infrastructure, reducing child mortality and infectious diseases.

#StrategicHealthCommunication is critical, especially in low-income nations with limited resources. It involves profoundly understanding the local context, target audience, and the cultural factors affecting health behaviours. Effective strategies include audience analysis, evidence-based messaging, channel selection, deliberate message distribution, and rigorous monitoring and evaluation.

In a post-colonial world, #LeadershipCommunication plays a pivotal role in low-income countries, where building trust, mobilizing resources, influencing behaviour change, strengthening health systems, and managing crises are paramount. National health leaders must communicate effectively to instil trust, mobilize resources, drive behaviour change, and forge alliances to strengthen health systems. Above all, it requires national health leaders to be loyal to their mandate and not merely in the service of international donors.

For health leaders, national and international, talking selectively, concretely, and effectively may be better at preventing health message fatigue than generating endless noise using fluff and jargon to have their faces plastered over posts and posters.

As we move forward post-COVID-19, it’s crucial to recognize the potential pitfalls of health communication fatigue. Strategic health communication and effective leadership communication are essential to navigate this landscape successfully. By striking the right balance, prioritizing critical health days, and ensuring that public officials don’t lose sight of their core responsibilities, we can ensure that our public health messages effectively achieve our goals.

Ageing & Travel: The Policy-Practice gap

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Ageing and Travel a policy practice gap

I had come to see off my eighty-four-year-old uncle, who uses a wheelchair at Kathmandu’s Tribhuvan International Airport. He was flying to New Delhi. We had chosen to fly him with India’s premier airline, Vistara, which prides itself on its joint ownership by two iconic brands, TATA and Singapore Airlines. Not to leave anything to chance, his son booked him on Business Class.

Kathmandu airport has two business lounges – the one managed by Radisson Hotel is a twenty-odd-step climb on the first floor. There are no elevators. Soltee Hotel operates the second lounge, which is on the ground floor. While the airline had booked a wheelchair for my uncle, it invited him to the first-floor lounge as it only had an agreement with the Radisson lounge. Forty minutes of discussion with three staff levels later, Visatara finally agreed to make an exception and allow him to the ground floor lounge. Had I not persevered, my uncle would have been denied using a lounge he was entitled to because of his #age and #disability.

The Nepal office of the otherwise outstanding Vistara had not used the prism of disability and ageing when deciding to make an exclusive contract with one lounge, while other international airlines operating out of Kathmandu hedge their bets and let passengers choose a lounge.

Making policies and guidelines on disability and #ageing requires complex-multidimensional #advocacy and leadership communication. Ideally, the organizations would have an ageing and #disability focal point that would be empowered enough to examine all client-facing decisions of the organization through the ageing and disability lens. The Human Resources heads need to ensure that in their induction programs, disability and ageing are featured in the curricula.

Clearly articulated leadership communication on a company’s commitment to creating inclusive products is a must and needs to be frequently repeated. There are, of course, trailblazers- Satya Nadella, CEO of Microsoft, has spoken publicly about his commitment to making Microsoft products and services accessible to everyone. He believes that people with disabilities can significantly contribute to the workplace. Similarly, Julie Sweet, CEO of Accenture, has said that her firm is committed to creating a culture of equality where everyone can advance and thrive and making its products and services accessible.

Soon, more airlines and airport operators will realize the economic imperative of using the ageing lens in business decisions. WHO predicts that the number of people aged 65 years and older will increase from 1 billion in 2020 to 1.6 billion in 2050. Similarly, the number of older adults who travel internationally will increase from 100 million in 2015 to 260 million in 2030.

Growing up, I have known my uncle as a confident person whose wit and swift decision-making always got him out of any tight spot. He has been a sportsman for the better part of his life. However, with age, I see irreversible changes which make airports and flights a challenge, especially when travelling alone.

#Airports can be large and complex, with long distances, confusing signage, and crowds. Elderly passengers may have difficulty finding their way around, especially if unfamiliar with the airport. Trust in the person pushing your wheelchair is critical for not getting an anxiety attack. A pleasant surprise was the Special Assistance staff at Delhi’s IGIA airport. The gentleman pushing the wheelchair was experienced in dealing with elderly passengers and showed patience and compassion at every stage of the journey. This highlights the importance of appropriately recruiting and training staff dealing with elderly passengers.

Airlines must understand the challenges elderly passengers face to provide them with the best possible experience. Luckily, there are global best practices that go beyond the standard priority boarding, wheelchair assistance, and special seating.

Japanese airports have several features that make them more accessible for elderly passengers, such as clear and concise signage, elevators and escalators throughout the airport, and accessible restrooms. The UK government has a program called the “Passenger Assistance Request Service” (PARS), which allows passengers to request assistance with tasks such as boarding and disembarking the plane, using the restroom, and managing their luggage. The United States has many laws and regulations in place to protect the rights of elderly and disabled passengers. For example, the Air Carrier Access Act (ACAA) requires airlines to provide reasonable accommodation to passengers with disabilities. The ACAA also prohibits airlines from discriminating against passengers with disabilities. This might be why Delta, United and American Airlines CEOs have often publicly committed to making their products friendly for older people.

More airlines and airport operators are starting to realize the economic benefits of considering the needs of older travelers in their business decisions. By 2050, the number of people aged 65 and older is predicted to reach 1.6 billion, with international travel expected to increase from 100 million in 2015 to 260 million in 2030. To provide the best possible experience for elderly passengers, airlines need to understand the unique challenges they face. Fortunately, there are global best practices available that go beyond standard accommodations. The World Health Organization and Centers for Disease Control and Prevention recognize the importance of travel for older adults, but it’s important for them to be aware of the potential risks and take necessary precautions.

It is important to note that the needs of elderly passengers can vary depending on their circumstances. Airports and Airlines should be prepared to work with elderly passengers to identify and address their individual needs and train their staff to deal with elderly passengers. This includes training on how to identify and address the needs of elderly passengers and provide them with the best possible service.

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) both recognize the importance of travel for older adults. Travel can allow older adults to stay active, learn new things, and connect with loved ones. However, it is crucial for older adults to be aware of the challenges they may face when travelling and to take steps to mitigate those risks.

There are several things that older adults can do to prepare for travel, including:

    • Get a check-up from their doctor before travelling.

    • Make sure their vaccinations are up to date.

    • Get travel insurance.

    • Plan what to do if they get sick or injured while travelling.

    • Getting vaccinated against travel-related illnesses.

    • Practising good hygiene, such as washing their hands often and avoiding contact with sick people.

    • Eating and drinking safely.

    • Taking precautions to avoid mosquito bites.

It is also recommended that older adults plan what to do if they get sick while travelling. This plan should include:

    • Knowing where to go for medical care.

    • Having a list of important phone numbers, such as the number of their doctor and their travel insurance company.

    • Having a plan for how to get home if they need to be evacuated.

Aeroplane manufacturers Airbus and Boeing are already working on several initiatives to make their aircraft more accessible to people with disabilities, such as wider aisles and more accessible lavatories. They are also working with airlines to create new training programs for flight attendants to assist passengers with disabilities.This is all great; however, for elderly passengers and those with disabilities, reaching the aircraft comfortably is the first challenge. It’s time for #airlines and airports to put on the lenses of ageing and disability and then up their game.

Dr Sunoor Verma is a global health diplomat-practitioner specializing in strategic partnerships, high-level advocacy, and strategic leadership communication.

An abridged version of this article has been published in Nepal’s English language daily The Annapurna Express on 6 October 2023, page 4.

 

Navigating Menopause at Work: A Vital Conversation

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The gap between the global South and the global North is widening in mainstreaming #menstruation in public discourse. Conversations about menstruation are only now emerging from the shadows of stigma and taboo in many parts of the global South. It is still difficult for people in these areas to access menstrual hygiene products, adequate sanitation facilities, and menstrual education. For example, Women and girls in sub-Saharan Africa and South Asia often resort to using inadequate materials like rags, leaves, or even cow dung to deal with their periods. Health problems, missed days of work or school, and feelings of isolation worsen when people aren’t given the tools they need to succeed.

The global North has made progress in normalizing menstruation. Many North American and European countries encourage menstruation discussions in homes, schools, and the workplace. The UK and several European countries have menstrual leave rules that allow workers to take paid absence for severe period symptoms. People in the US are fighting to end the “pink tax” on period goods, and more companies are discussing menstrual health with their staff. Development, access to resources, and cultural attitudes about menstruation contribute to this North-South gap, emphasizing the need for global menstrual health and hygiene fairness.

#Menopause is a natural transition that occurs when a woman’s ovaries stop producing estrogen and progesterone hormones. Between the ages of 45 and 55, symptoms of this condition can manifest physically and emotionally.

Menopause can cause uncomfortable physical symptoms, including hot flashes, night sweats, vaginal dryness, and fatigue. These symptoms can make a woman’s life miserable and make it difficult for her to do her job. Menopause’s emotional symptoms can be just as trying as the physical ones. Mood swings, anxiety, and depression are all possible for women. The inability to concentrate due to these symptoms can hurt personal relationships and professional output.

Menopause can have a financial impact on women in addition to the physical and emotional symptoms.Women who experience menopause may need to take time off work to manage their symptoms, and they may also need to see a doctor or other healthcare provider. These costs can add up, making it difficult for women to make ends meet.

Menopause is taboo, making it challenging to address the issue openly. Many women experience shame or embarrassment when discussing their symptoms, and they may not want to bother their coworkers or superiors. Because of this, women may have trouble getting the help they require. When companies take the time to learn about menopause, they can better accommodate their female employees. This has the potential to boost employee morale, output, and health.

Businesses can take various steps to establish a more inclusive and understanding workplace for menopausal women. First and foremost, companies must acknowledge that many employees may be inexperienced with menopause symptoms. Employers can educate staff on menopause and its effects to fill this knowledge gap. Businesses may foster understanding and empathy by raising awareness. Creating a friendly environment for menopausal discussions is also essential. Employees should feel comfortable discussing menopause with bosses and coworkers. This open discourse can help menopausal women manage work by fostering compassion and solidarity among coworkers.

For menopausal women, employment flexibility can alter everything. This life stage’s physical and emotional obstacles may demand work schedule modifications. Businesses can offer telecommuting or flextime to meet these needs. These arrangements can help women balance employment and health. Supporting menopausal women also requires healthcare. Health insurance or on-site medical care from employers can help women throughout this transition.

Menopause policies are spreading in companies in the global North. Employees receive full menopause assistance from Pfizer UK. Pfizer trains managers on menopause and staff support. This program encourages discourse and stigma reduction. Menopausal women can feel supported at Channel 4 (UK) “menopause cafes”, where staff can share their experiences and suggestions. Since implementing a menopausal policy with flexible work choices, management training, and a support network, Barclays UK has seen reduced absenteeism and greater employee satisfaction and retention.

Smaller firms may lack the resources of larger ones. By providing educational materials and manager training, they can support menopausal employees. They can also share information about menopause support networks and external resources. These free or low-cost resources can help employees who need more guidance.

Inclusive period and menopause policy Scottish ParliamentThe Scottish Parliament and the Welsh Government agree that workplace menopause policies are humane, inclusive, and strategic. Both supported their staff, including Scottish Parliamentarians, with a menopausal policy. Feedback showed that employees and MPs were more comfortable discussing menopause, creating a more inclusive and understanding workplace. These rules boost employee well-being, productivity, cost savings, and corporate brand. Organizations can boost workforce and economic performance by meeting menopause-related requirements.

Over the last two to three years, the global South vs. global North debate has rekindled. While disagreements over trade, intellectual property and nuclear energy will continue, the least we can do is to bridge the menstruation gap between the global North and global South. The increasing number of women parliamentarians in South Asia will hopefully help address the gap in the menstruation discourse.

Dr Sunoor Verma is a global health diplomat-practitioner specializing in strategic partnerships, high-level advocacy, and strategic leadership communication.

This article was also published in the print version of The Himalayan Times on 2 October 2023.

Navigating Menopause at the workplace

Chief Justice of India delivers a powerful lesson in Leadership Communication.

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CJI Chandrachud delivers a masterclass in leadership communication: An analysis by Sunoor Verma

In his remarks at the 31st annual convocation of the National Law School Bangalore, Chief Justice of India DY Chandrachud displayed exceptional #leadershipcommunication qualities. In his remarks, CJI Chandrachud addressed the  “taboo” topic of #menstruation and the difficulties that #women #lawyers confront in juggling their careers and personal lives. He also related a personal story about his late former wife being instructed to “find a husband who can manage household chores” when she inquired about working hours at a legal company.

In sharing this story, CJI Chandrachud was willing to discuss complex topics and challenge the status quo. He also showed that he is aware of women lawyers’ challenges and is committed to creating a more inclusive and supportive workplace for them.

In the best-case scenario, male leaders address women’s issues on International Women’s Day or when requested to speak at a women-focused event. What lifted Dr Chandrachud’s speech to a leadership speech was that he mainstreamed women and their issues in a convocation speech. This sends a strong message to other leaders that women’s issues must take centre stage in New India.

Here are some of the exemplary leadership communication traits that CJI Chandrachud demonstrated in his speech:

  • He was authentic and transparent. CJI Chandrachud did not shy away from sharing a personal story highlighting women lawyers’ challenges. This showed that he is willing to be open and honest about these issues, even when challenging.
  • He was empathetic and supportive. CJI Chandrachud expressed empathy for women lawyers’ challenges and supported them by allowing his female law clerks to work from home when they experience menstruation-related health issues. This shows that he is committed to creating a more inclusive and supportive workplace for women.
  • He was inspiring and aspirational. CJI Chandrachud’s speech was inspiring and aspirational for young lawyers, particularly women. He challenged them to think about their challenges and work to create a more just and equitable world.

CJI Chandrachud’s speech is a reminder that leadership communication can address complex topics and create a more inclusive and supportive workplace for all. By being authentic, empathetic, supportive, inspiring, and aspirational, CJI Chandrachud demonstrated exemplary leadership communication traits.

In addition, CJI Chandrachud also demonstrated the following characteristics in his speech:

  • He was courageous. It took courage for CJI Chandrachud to share a personal story about the challenges his late former wife faced as a woman lawyer. This is a personal story and can be challenging to talk about.
  • He was humble. CJI Chandrachud acknowledged that the situation has improved for women lawyers since his late former wife’s time. He also admits that he could be better and that there is still more work to create a more inclusive and supportive workplace for women.
  • He was hopeful. CJI Chandrachud ended his speech by expressing hope for the future. He challenged young lawyers to think about their challenges and work to create a more just and equitable world.

Leaders’ silence on menstruation and other pro-women issues contributes to stigma, shame, and inequality. Women are less likely to discuss these issues, seek help, or access resources when they are taboo. This can devastate their physical and mental health and their ability to achieve #equality in society.

The silence of leaders on women’s issues:

  • Is a form of discrimination.

  • Sends the message that these issues are not important.

  • Contributes to the cycle of violence against women.

Menstruation-related discrimination is a long-standing issue in the workplace that has received little attention. It is vital to remember that Menstruation-related job discrimination:

  • Is a form of sex discrimination. It is illegal to discriminate against someone based on their sex, including their menstrual status.
  • Can take many forms. It can include being denied time off work for menstrual-related reasons, being asked to provide medical documentation for menstrual-related absences, or being subjected to harassment or bullying because of menstruation.
  • Can have a severe impact on women’s careers. It can lead to women missing out on opportunities for advancement, being passed over for promotions, and being terminated from their jobs.

CJI Chandrachud’s speech is a powerful reminder that menstruation-related discrimination is a real problem and must be addressed. By speaking out against this form of discrimination, CJI Chandrachud is helping to create a more just and equitable workplace for all women.

Dr Sunoor Verma is an expert in advocacy and strategic leadership communication. During the COVID-19 pandemic, Dr Sunoor provided in-person crisis, risk, and leadership communication training to over 300 Nepalese parliamentarians on behalf of WHO. He also coached four Ministers of Health and four Ministry of Health spokespersons in strategic and crisis communication.

Dr Sunoor has advised WHO, UNICEF, UNHCR, UNDP, ECMI, and their leaders in developing sophisticated coalitions, successfully communicating, and inventing out-of-the-box solutions in development and humanitarian settings. He has also collaborated on international relations, global health, and conflict resolution programmes with Boston University, the University of Geneva, and Cambridge University. Dr Verma coaches and advises elected officials and technocrats in practical science and crisis communication as part of his leadership communication practice.

Learning from Rwanda’s Rise: Insights from the Kigali Global Dialogue Forum 2023

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Dr Sunoor Verma speaking at the Kigali Global Dialogue 2023 Interview with Dr Sunoor Varma

Global Development Strategist and Leadership Communication expert

The developmental experiences of Rwanda and their applicability to countries such as Nepal are explored in an interview with Dr Sunoor Verma.

The Kigali Global Dialogue Forum is a one-of-a-kind forum that brings together representatives from developing countries to discuss major global issues. It is organised by India’s Observer Research Foundation (ORF) and the Rwanda Governance Board. Set against Rwanda’s incredible growth and development, this selected event focuses on inclusive conversation, bringing varied perspectives, and supporting gender equity. The critical findings are the importance of open discussions, regional alliances, and issue-based collaborations among developing nations.

Welcome to Nepal News Agency. Dr Sunoor Verma will be with us today to discuss developing countries such as Nepal and Rwanda. You were recently invited to speak at the Kigali Global Dialogue; please explain your personal experience and impressions of participating in this unique event in Rwanda.

Dr Sunoor Verma: The Kigali Global Dialogue is a truly unique platform for debate that is convened by two highly credible organisations, the Observer Research Foundation, India and the Rwanda Governance Board, and it brings together a diverse range of voices from developing countries. This dialogue is known for ensuringa significant presence of women speakers, which is not always the case at international events.”

Another thing that makes the Kigali Global Dialogue special is that it’s held in Rwanda, one of Africa’s fastest-growing economies. It’s an inspiring place to be, giving us a glimpse of what’s possible for developing countries.

The topics discussed at the Kigali Global Dialogue are also very bold. They don’t shy away from complex issues; participants can express their views without worrying about pleasing donors or funding sources. This makes for a candid exchange of ideas essential for developing countries.

The Kigali Global Dialogue is an invaluable platform for developing countries to come together, discuss critical issues, and learn from each other’s experiences. I’m grateful for the opportunity to participate in this year’s event, and I look forward to returning.

Can you share some insights that you gained from participating in the dialogue?

Dr Sunoor Verma: One of the most significant insights I gained from the dialogue was the continued relevanceof dialogue between developing countries. Too often, the conversation about development is dominated by developed countries, who may not always understand the unique challenges and opportunities facing developing countries. The Kigali Global Dialogue was a refreshing change of pace, as it was a platform for developing countries to come together and share their experiences. This was incredibly valuable; we could learn from each other and build relationships. Another insight I gained was the importance of regional alliances and issue-based alliances. In today’s world, it is no longer enough to focus on national development simply. We need to work with our neighbours and countries facing similar challenges. This is the only way to achieve sustainable development. The Kigali Global Dialogue was a wake-up call for many. It is a sobering reminderthat developing countries have the power to shape their destiny. We must continue coming together, sharing our experiences, and building alliances. Together, we can create a better future for all as long as there are credible hosts, such as the Observer Research Foundation and the Rwanda Governance Board, whose intentions are trusted.

Dr Sunoor Verma speaking at Kigali Global Dialogue 2023

So the dialogue was held in Rwanda, and its Kigali Global Dialogue and such dialogues have helped the country garner international attention; so can you elaborate on how these dialogues have effectively promoted Rwanda’s achievements and helped foster global engagement?

Dr Sunoor Verma: The Kigali Global Dialogue is a powerful asset for Rwanda to showcase its achievements to the world without being a pony show. It brings together a wide range of influential people from all over the world who get to see firsthand Rwanda’s progress in recent years. This year’s dialogue, for example, brought together people from over 70 countries. They had the opportunity to learn about Rwanda’s economic growth, its commitment to good governance, and its progress in education and healthcare. They also had the chance to meet with Rwandan policymakers and business leaders and discuss ways to collaborate on future projects.

However, The Kigali Global Dialogue is not just about promoting Rwanda’s achievements. It is also about fostering global engagement. When policymakers and business leaders worldwide come together in Kigali, they can build relationships and share ideas. This can lead to new partnerships and new development opportunities.

Rwanda has made some significant improvement in development despite the genocide that occurred not long ago, so what are the factors or strategies that do you believe contributed to Rwanda’s transformation into current Africa’s fastest developing nation?

Dr Sunoor Verma: Rwanda’s transformation always inspires me; it is a remarkable story of how a country can overcome a horrific past and build a brighter future. Many factors have contributed to Rwanda’s success, but I believe the most important ones are visionary leadership, good governance, and investment in human capital.

President Paul Kagame has been a visionary leader for Rwanda. He has articulated a clear vision for the country’s future and has been committed to implementing it. He has also created a robust, stable government focused on good governance and transparency. This has created an environment where businesses can thrive, and people can live in peace and security.

Rwanda has also invested heavily in education and healthcare. This has led to a significant improvement in the quality of life for its citizens. The country now has one of the highest literacy rates in Africa and is also making progress in reducing poverty and malnutrition. Rwanda is also a leader in gender equality, with women making up more than half of the parliament. I am confident that Rwanda will continue to thrive in the future.

I speak passionately about Rwanda’s transformation because it is a model for other developing countries. The principles of visionary leadership, good governance, gender equity and investment in human capital are the same principles that I believe can be applied to other developing countries.

As you said, the society was torn from violence and ethnicity, and now it is embracing its unity; that transition is indeed remarkable for a landlocked country or small country like Rwanda, so what do you believe are the key factors that enable this transition and how can other countries with a similar situation, similar socio-economic problems can learn from Rwanda’s experience.

Dr Sunoor Verma speaking at Kigali Global Dialogue 2023

Dr Sunoor Verma: Rwanda’s transition from a country torn by violence and ethnicity to embracing unity is remarkable. It is a story of how a country can overcome a complicated past and build a brighter future. Many factors have contributed to Rwanda’s success, but the most important ones are leadership, reconciliation and gender equality.

Leadership is essential for any country that wants to achieve its goals. President Paul Kagame has understood the importance of Reconciliation in Rwanda and has taken steps to promote it. He has also committed to gender equality, and women now play a leading role in all aspects of Rwandan society.

Reconciliation is another essential ingredient for peace and unity. Rwanda has taken several steps to promote Reconciliation, including creating a system of local courts and local bodies to help people reconcile with each other. The country has also integrated the issue of Reconciliation into its school curriculums.

Gender equality is also essential for peace and unity. When women are empowered, they are more likely to be involved in decision-making and promote peace. Rwanda has made significant progress in gender equality; women now comprise more than half of the parliament.

Reconciliation is a difficult process, but it is critical in countries that have suffered genocide or other mass tragedies. It is the only way to fully move past the past and create a better future for everyone. Reconciliation does not imply ignoring the past. It is about remembering the past in order to create a better future. It is about acknowledging the grief and suffering inflicted and working together to find a way forward. It is a matter of forgiveness, not forgetting. It is about justice, but not about vengeance. It is a process of healing, not forgetting.

Rwanda has focused a lot on agricultural development to progress since the genocide. Nepal is also an agro-based country, so what methods used by the people of Rwanda can be applicable for Nepal to develop agriculturally?

Dr Sunoor Verma: Rwanda is a remarkable example of a country that has transformed itself from a low-income, post-conflict country to a high-performing economy in just two decades. One of the key drivers of this transformation has been Rwanda’s focus on agricultural development.

Rwanda has invested heavily in agriculture, both in terms of infrastructure and technology. The country has built a network of irrigation canals and dams and introduced new technologies such as drip irrigation and solar-powered pumps. This has helped to increase agricultural productivity and reduce vulnerability to drought.Rwanda has also invested in agricultural research and development. The country has established several agricultural research centres and partnered with international organisations such as the International Maize and Wheat Improvement Center (CIMMYT) to develop new varieties of crops resistant to pests and diseases.

In addition to infrastructure and technology, Rwanda has also focused on good governance and gender equity in agriculture. The government has put in place many policies to promote women’s participation in agriculture and has also made efforts to reduce corruption in the agricultural sector.

As a result of these investments, Rwanda has achieved significant progress in agricultural development. The country’s agricultural output has doubled in the past two decades, and poverty has been reduced by half.

Nepal can learn a great deal from Rwanda’s experience in agricultural development. Nepal is also agro-based, facing many of the same challenges as Rwanda. However, Nepal has the potential to achieve similar results if it invests in infrastructure, technology, good governance, and gender equity in agriculture. I am confident that Nepal can follow in Rwanda’s footsteps and transform into a high-performing economy. It is only a matter of commitment and determination.

For a country like Nepal which is quite similar to Rwanda as it has faced many transitions in the political system, it is now a democratic country experiencing several changes in the political system. So in your view, what aspects of Rwanda’s governance leadership and policies can benefit countries like Nepal facing similar political changes

Dr Sunoor Verma speaking at Kigali Global Dialogue 2023

Dr Sunoor Verma: I have been impressed by Rwanda’s progress in recent years, and I believe that the country has much to offer other developing countries facing similar political changes.

One of the most striking things about Rwanda is its political vision. The government has a clear and long-term plan for the country and has been able to implement this plan effectively. This is in contrast to many other developing countries, which often have frequent changes of government and lack a clear vision for the future.

Another critical aspect of Rwanda’s governance is its political stewardship. The government has channelled international support and technical assistance in a way that has benefited the country as a whole. This contrasts with many other developing countries, where international aid is often fragmented and does not reach the people who need it most.

Finally, Rwanda has made significant progress in gender equality. This contrasts with many other developing countries, where women, including Nepal, are still underrepresented in decision-making roles.

I believe these three aspects of Rwanda’s governance can benefit other developing countries facing similar political changes. If these countries can create a clear vision for the future, channel international support effectively, and promote gender equality, they can achieve significant progress in their development.

I am particularly passionate about the issue of gender equality. I believe that when women are empowered, they can make a real difference in the development of their countries. Rwanda is an excellent example of a country that has benefited from gender equality. I hope other developing countries will follow Rwanda’s example and allow women to lead their societies.

As you said before, Rwanda has garnered a lot of tourist attention. Nepal is also a little bit inclined towards tourism development. It is trying to develop more tourism in the country. It has more tourist attractions than Rwanda, but still, it is not as successful as Rwanda. So what could be the cause behind it and what steps can Rwanda take, and what methods that Rwanda has applied can be applicable in Nepal in developing the tourism sector?

Dr Sunoor Verma: Nepal is a beautiful country with a lot to offer tourists, but it has not been as successful as Rwanda in attracting tourists. If we analyse how Rwanda has achieved this feat of attracting high-value, high, spending tourists, we will find that the answers lie in good governance, branding, and infrastructure.

Good governance: Rwanda has a reputation for being a well-governed country with low levels of corruption. This is important for tourism, as tourists want to feel safe and secure when they travel. Lesson number one- Corruption deters high-spending tourists from visiting a country.

Branding: Rwanda has done an outstanding job branding itself as a tourist destination. The country is known for its gorillas, beautiful scenery, and friendly people. The lesson, Two: Political and economic instability is not conducive to solid branding.

Infrastructure: Rwanda has invested heavily in infrastructure, such as roads, airports, and hotels. This makes it easy for tourists to get around the country and enjoy their visit. Lesson, Three: infrastructure for safe connectivity and secure accommodation is critical.

In addition to these three areas, Nepal can also improve its tourism sector by addressing the following issues:

Gender equality: Nepal has a long history of gender inequality. This can deter female tourists from visiting the country. Nepal needs to do more to promote gender equality and to create a more welcoming environment for female tourists.

Tourism education: Nepal needs to invest in tourism education. This will help to create a more skilled workforce in the tourism sector and will also help to raise awareness of the importance of tourism.

Sustainable tourism: Nepal needs to develop sustainable tourism practices. This will help to protect the environment and to ensure that tourism benefits the local community.

I believe that Nepal has the potential to become a significant tourist destination. However, it needs to address its challenges to realise its full potential.

Lastly, what do you think, methods or formulas Rwanda used to be this successful within two decades? And how would you compare their political system and their development with Nepal’s development?

Dr Sunoor Verma: I have been working in international development for over 20 years and have seen many countries progress, but Rwanda is one of the most impressive success stories. In just two decades, Rwanda has transformed from a country ravaged by genocide to a thriving and prosperous nation.

Many factors have contributed to Rwanda’s success, but I believe that the following are the most important:

Evidence-based decision-making: Rwandan leaders have committed to using evidence to guide their decisions. This means that they have invested in research and analysis and are willing to change course if the evidence shows that they are on the wrong track.

Political will: Rwandan leaders have shown a strong commitment to development. They have made it a priority to improve the lives of their citizens, and they have been willing to make difficult decisions to achieve their goals. There appears to be an agreement among the politicians of Rwanda on a common minimum national interest agenda.

Gender equality: Rwanda has made significant progress in gender equality. Women comprise more than half of the parliament, leading in all aspects of society. This has helped to create a more just and equitable society, and it has also contributed to economic growth.

Public participation: Rwandan leaders have committed to public involvement. They consult with citizens regularly, and they are responsive to their feedback. This has helped build trust between the government and the people, making it easier to implement reforms.

Finally, the Rwandan leadership has maintained stewardship of its National Development agenda and has not allowed foreign interference while being open to considering global best practices.

Published in Polar News, Nepal on 17 August 2023

Dr Sunoor Verma speaking at the Kigali Global Dialogue 2023

The art of making a massive health impact.

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public health communication multi-stakeholder engagement singapore

A call to active lifestyle by Singapore health authorities.

How can a small island nation with a multi-ethnic and multilingual citizenry and four official languages become a global champion in health communication? The answer is to use scientific evidence effectively, to be proactive in responding to evolving trends, to employ many communication channels, and to tailor messages to diverse audiences. And the country with this extraordinary feat will be 58 on August 9, 2023. It’s #Singapore!

Singapore’s demographics are rapidly shifting, posing significant challenges for the country’s health systems. The population is ageing, with the median age anticipated to reach 49 by 2030, as is the proportion of people suffering from chronic diseases. While many chronic diseases can be avoided or delayed, they are expensive to treat when they do develop. Singapore has a higher suicide rate than many other countries, and mental illness is stigmatized. Similarly, the prevalence of obesity rates in Singapore is rising, especially among children and adolescents. And Singapore is addressing all these head-on.

During my visits to Singapore, I can’t help but see behaviour change signals everywhere, some subtle and some direct. Singapore’s health authorities appear to be working on a war footing to confront emerging health concerns by investing in exceptional health communication.

As a strategy and leadership communication professional, I consider Singapore’s approach to be an accurate implementation of “Health is a Human Right” and “Health in All Policies.”

When I decipher Singapore’s magical public health communication formula, I discover the following precious principles:

One, Audience: Understanding your audience is essential to any public health communication strategy. Who are you targeting? What are their concerns? What drives them? After knowing your audience, you may personalize your message. However, this requires leaving your cosy offices and connecting with people in their homes or workplaces. Public health authorities must likewise give up the idea that they know what’s best for people.

Two, Relevance: your message should address your audience’s worries. They should care about it and recognize how it affects them. In contrast to Singapore, which determines its agenda with limited foreign intervention, low-income countries frequently follow the priorities of their international donors.

Third, Credibility: your message should be founded on solid evidence and originate from a reliable source. As in Singapore, this is made possible by multi-sectoral collaboration. Four, Engagement: your message should be engaging and thought-provoking to captivate your audience. It should inspire curiosity and action. Five, Simple messaging: Your message should be easy to understand and avoid jargon and technical terminology.

Singapore’s health communication formula also includes using a variety of mediums to engage people, such as print, television, radio, social media, and public events. Use humour and storytelling to connect with your audience. Track your public health communication campaign’s performance to see what works and what doesn’t, as this helps campaigns improve over time.

Feedback on health messaging is critical to improve campaigns.

Collecting feedback from audiences on health messaging is critical to improving campaigns.

Singapore has many public health successes. Singaporeans’ rising Type Two Diabetes rate prompted the 2016 “War on Diabetes” campaign. The 2015 “National Steps Challenge” to promote physical activity saw fivefold participation by 2018. The government has created an extensive initiative to support firms of all sizes in obesity prevention and management, chronic illness management, mental health, and smoking cessation.

Singapore’s health initiatives’ interconnectedness is their beauty. The government works with the urban planning sector to design localities that encourage physical activity; with the transportation sector to promote public transportation and make it easier for people to walk, cycle, and use active modes of transportation; with the education sector to promote health education in schools and create a healthy school environment; and with the workplace sector to encourage healthy workplaces.

By linking its public health programs with other vital sectors, Singapore has created a more holistic approach to health promotion that benefits the entire population.

Understanding that communication is a means to an end is critical to Singapore’s health communication success.  Singapore’s health communication programmes are proactive, evidence-based and serve measurable health objectives—infrastructural investments back health campaigns. To give Singaporeans a place to exercise, relax, and mingle this “Planned City” features government-built 59 regional and 271 community parks. They usually have running, cycling, and inline skating paths that link to nearby parks. Parks have many outdoor workout stations. The government also provides healthcare subsidies. This guarantees quality health care for all.

Leadership by example is also a part of Singapore’s health communication strategy. It sends a strong message to the public that healthy living is essential when Singaporean leaders and top civil servants follow what they preach. This encourages better choices. Singapore’s leadership communication strategy frequently includes health and lifestyle messages, demonstrating their importance as a national priority.

What also helps is that Singapore has traditionally had stable governments with enough majority to expedite health-related legislation. The other significant and rare advantages that Singapore enjoys are – one, Singapore has a long history of electing highly educated and trained science political officials, due in part to the country’s emphasis on education and its commitment to developing a knowledge-based economy and two, the presence of an impressive number of self-made female professionals in high-decision making roles. This is recognized to lead to better representation of women’s interests, more diversity of thought, and more decisive leadership.

Why are so few Asian countries able to reproduce the basic recipe for effective health communication a la Singapore? Because corruption, nepotism, or political and bureaucratic greed come in the way.

Singapore’s public health ambassadors are chosen for their health advocacy, not political connections. Singapore’s health promotion platforms are not chosen for personal profit. Similarly, posters and brochures are printed in proportion to audience size instead of commission. Health authorities in many developing Asian nations have piles of obsolete printed material rotting in their warehouses.

Singapore’s performance suggests good governance and low corruption are necessary for effective health communication. Transparency International‘s Corruption Perceptions Index 2022 ranks Singapore fifth least corrupt country out of 180 nations. In 2023, the Chandler Institute of Governance ranked Singapore top in good governance, ahead of Switzerland, Finland, Denmark, Norway, Sweden, the Netherlands, Germany, the UK, and New Zealand.

International development and philanthropic health programmes in low-income countries need to learn from Singapore’s health communication excellence. In the absence of national-level good governance and the presence of high corruption perception among the population, investing in public health communications is bound to yield poor returns.

Donor funding for health communication is highly susceptible to corruption, causing anger over “failed” health promotion efforts and raising questions over donor credibility. So, unless international donor-development agencies want to mainly boost a country’s t-shirt, flex, and poster printing business or provide politicians with a health platform for self-promotion, the funding of health communication portfolios should be carefully reviewed.

Thank you, Singapore. Keep inspiring!

An abridged version of this article appears on page 4 in The Himalayan Times, Nepal, 9th August 2023.

Dr Sunoor Verma is a global health diplomat-practitioner specializing in strategic partnerships, high-level advocacy, and strategic leadership communication. He has supported the work of WHO, UNICEF, UNHCR, UNDP, ECMI and their leaders in building complex coalitions, communicating effectively and devising out-of-the-box solutions in development and humanitarian settings. He has also worked with Boston University, the University of Geneva and Cambridge University on programs that intertwine international relations, global health and conflict resolution.

 

Sex Education for Boys is good for national economies.

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Sexual Reproductive Health, Boys, Education South Asia

 

What is SexEd?

Sex education is a powerful tool that equips young individuals with accurate information about sexual and reproductive health. Beyond its social and health benefits, comprehensive sex education for boys also holds significant potential to impact a nation’s economy positively.

Patriarchal Norms in South Asia

In the unique cultural context of South Asia, where gender disparities prevail, focusing on sex education for boys becomes crucial. The region is characterized by deeply ingrained patriarchal norms and traditional gender roles, perpetuating unequal power dynamics in relationships and fostering unhealthy behaviours. Sex education can challenge these norms, promoting respectful attitudes towards women and encouraging gender equality. The rise in violence against women in developing countries is a serious problem that has several causes, including poverty, inequality, and harmful gender norms. One of the most critical factors contributing to this problem is the lack of comprehensive sex education for boys.

Disturbing Evidence

Of course, sex education is essential for girls as well. However, the specific challenges facing boys in South Asia make it especially important to engage them in this conversation. There is ample data to show that boys in South Asia are more likely to be the perpetrators of sexual violence, to be infected with HIV and other Sexually Transmitted Infections (STIs), and to be marginalized from sexual health services.

Disturbing statistics released by the United Nations Population Fund (UNFPA) in its 2023 ‘The State of the World’s Population Report’ shed light on the lack of sex education in South Asia. Merely 20% of schools in the region offer sex education, and only 10% provide comprehensive information on contraception, STIs, and abortion.

Consent, Communication, and Mutual respect

Comprehensive sex education goes beyond the physical aspects of sexuality and focuses on building healthy and respectful relationships. Educating boys about consent, communication, and mutual respect can lead to more fulfilling and equitable partnerships, contributing to healthier family dynamics and societal harmony.

Unintended pregnancies and STIs pose significant challenges in South Asia. The adolescent birth rate in the region, at 22 births per 1,000 girls aged 15-19, is the highest in the world, partly due to limited information about contraception and reproductive health among boys. Educating boys about STIs and prevention strategies can make significant progress in controlling their spread.

By promoting attitudes of respect, consent, and gender equality, sex education for boys also plays a crucial role in breaking the cycle of gender-based violence, including intimate partner violence and early marriages. According to the World Health Organization’s (WHO) ‘Global Status Report on Violence against Women and Girls’ of 2022, 37% of women in South Asia have experienced physical or sexual violence from an intimate partner. Educating boys about the importance of non-violence and respect for women can contribute to advocating for a safer and more inclusive society.

Furthermore, comprehensive sex education empowers boys to understand their responsibilities as fathers and be actively involved in their children’s lives. This can improve child well-being, family outcomes, and a more stable and prosperous society.

Poverty not an excuse

Despite challenges like poor schools and untrained teachers, introducing and strengthening sex education is imperative. Governments should collaborate with non-governmental organizations, international agencies, and community leaders to provide supplementary training and resources. Online resources and educational materials should complement classroom instruction.

Growing National Pride- an opportunity

Governments in South Asian countries are increasingly embracing their ancient civilizations and cultural heritage in school curriculums to foster national pride. As part of this growing trend, they can draw inspiration from their historical sex education practices and combine them with modern scientific knowledge to introduce comprehensive sex education in schools. Ancient traditions, like teachings from the Kamasutra in India, tantric practices connecting sexual energy with spiritual growth in India and Nepal, and temple art portraying human sexuality in India, Sri Lanka, and Myanmar, offer valuable insights. Additionally, specific tribal communities in India, Bhutan, and Nepal marked boys’ transition to manhood with ceremonies that included teachings about adult responsibilities, including those related to sexuality, marriage, and family life. Ancient Hindu scriptures such as the Kamasutra, Mahabharata, Arthashastra and the Upanishads highlight the broader principles of respect, mutual understanding, and responsible behaviour within relationships. While not explicitly promoting modern sex education, these principles can serve as a foundation for discussing sexual health, consent, and maintaining harmonious relationships in contemporary contexts. By blending this traditional wisdom with modern evidence-based approaches, these South Asian countries must offer relevant and age-appropriate sex education, empowering their youth with knowledge and promoting responsible attitudes toward sexual health and relationships.

Integrating sex education into the curriculum addresses social issues and has significant economic implications, as an informed and accountable youth can contribute to a more stable and prosperous society.

Best practices from poor countries exist

Several developing countries have successfully implemented comprehensive sex education programs for boys, promoting responsible sexual behaviour, reproductive health, and gender equality. In the late 1990s, Brazil launched successful sex education initiatives alongside discussions about gender equality and healthy relationships leading to significant improvements in reducing teenage pregnancies and the prevalence of sexually transmitted infections among adolescents. The Kenyan government has integrated comprehensive sex education into the national curriculum, covering topics such as reproductive health, family planning, and HIV prevention. Thailand has a comprehensive sex education curriculum that has contributed to a decline in teenage pregnancies and a reduction in HIV transmission rates among young people.

Comprehensive sex education is not a silver bullet but an essential tool for preventing violence against women and building a more just and equitable society for all. Investing in comprehensive sex education for boys is a matter of social responsibility and has profound economic implications. By empowering the youth with knowledge and fostering responsible attitudes toward sexual health and relationships, South Asian countries can pave the way for a more informed, equitable, and prosperous future.

After all, sex education is like fire prevention. You may not need it today, but you’ll be glad you had it if you do!

By Dr Sunoor Verma

Published in print and online in The Himalayan Times on 31st July, 2023

For healthy & happy kids, reduce screentime now!

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Screentime, Screen addiction, Parenting

Sunoor is seen here narrating Dr Bindeshwar Pathak’s inspiring story to Sulabh International School students in Palam. Sunoor is the founder and series editor of the Namaste Series! a project that captures the inspiring journey of s/heroes from the global south and turns them into story books.

Published by Radio Nepal on 18 March 2023

Unreasonable screentime threatens children’s mental and physical well-being and is a significant parenting challenge today! According to the World Health Organization (WHO), 10% of youngsters over the globe suffer from mental problems. This is especially troubling, considering that childhood and adolescence are crucial periods for mental health. The brain undergoes significant growth and development during this period. Children and adolescents develop cognitive and social-emotional skills that influence their future mental health and are crucial for adopting adult roles in society.

Early adverse experiences in homes, schools, or digital places, such as exposure to violence, the mental illness of a parent or other caregiver, bullying, and poverty, raise the likelihood of developing mental illness. In addition, too much time spent in front of a screen has been related to sleep deprivation, speech delays, poor social skills, and other life issues. When screentime becomes an all-consuming pastime for youngsters, this is dubbed screen addiction.

What is unreasonable screentime and screen addiction?

Screen addiction describes the compulsive and excessive use of electronic devices such as smartphones, tablets, and laptops. While technology has undoubtedly made our lives easier, it has also had several detrimental implications, notably regarding mental health. Children are vulnerable to screen addiction, which can harm their mental health.

Addiction symptoms include the inability to stop taking the substance or when the substance’s use begins to interfere with one’s life or relationships. The symptoms are identical when it comes to youngsters and screens.

How does screen addiction impact health?

The increased risk of developing anxiety and despair is one of the most significant ways that screen addiction impacts children’s mental health. Excessive screen usage is related to elevated levels of stress, anxiety, and depression in youngsters, according to research. This is due to several factors, including the social isolation that frequently results from excessive use of electronic devices, the overstimulation of the brain that occurs when children are exposed to an excessive amount of visual and auditory stimuli, and the disruption of sleep patterns that can arise when screens are used too close to bedtime.

Your child’s danger of being exposed to cyberbullying and pornographic material increases as they spend more time on phones and other screens. Similarly, more time spent on social media is frequently associated with sadness and internalizing issues. In addition, spending more time in front of a screen is associated with a decrease in parental bonding, according to scientific research.

The negative impact of unreasonable screentime on Physical Health

In addition to harming children’s mental health, screen addiction can negatively impact their physical health. For instance, children who spend an excessive amount of time seated in front of screens are at risk for acquiring obesity, which is related to a variety of physical and mental health issues. In addition, excessive screen time can result in eye strain, headaches, and other physical pain, exacerbating stress and anxiety.

Reducing screen time for children can be challenging, mainly when screens are often used for entertainment and educational purposes. However, here are some practical tips for reducing screentime for children.

What can parents do to manage screen time for children?

Parents and caregivers must actively supervise their children’s screen time to reduce their excessive use of electronic devices. Establishing explicit guidelines and limits for screen use is one approach to this. For instance, parents may limit screen usage to a set number of hours per day or require screens to be turned off at least one hour before bedtime.

Key Tips

  • Use parental controls on the devices: Parental controls can effectively limit screentime and restrict access to certain apps or websites. Parents can use parental control features on devices or install third-party apps to help monitor and control their children’s screentime.
  • Encourage youngsters to participate in activities that support their physical and mental health as another method for reducing screen addiction. This could be outdoor play, reading, artistic pursuits, or time spent with friends and family. In addition, parents may limit the amount of time their children spend in front of screens and create healthy behaviours by encouraging their children to participate in these activities.
  • Establish tech-free zones at home: Establishing tech-free zones in the home, such as the dining table or the bedroom, can aid in reducing the amount of time youngsters spend in front of devices. In addition, to foster more face-to-face engagement and family time, parents can advise youngsters to leave their devices in another room during these times.
  • Finally, parents may exhibit responsible screen use. Children typically emulate their parents’ behaviour; therefore, if parents are constantly checking their phones or watching television, it is conceivable that their children will do the same. By demonstrating appropriate screen usage, parents can provide a positive example for their children and encourage the development of mental and physical health-promoting activities.

screentime, screen addiction, parenting, family time

Encourage youngsters to participate in activities that support their physical and mental health as another method for reducing screen addiction. This could be outdoor play, reading, artistic pursuits, or time spent with friends and family.

Action points for advocacy organisations

Organisations advocating for children’s mental health need to develop new strategies to integrate screentime advocacy into their mandate. Similarly, strategic partnerships in the public and private sectors must be established to address the growing challenge of screen addition.

Published by Radio Nepal on 18 March 2023

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Additional Resources

  1. Here is a  fantastic article with a step-by-step “How to.. ” Guide to screen addictions and responsible digital use by Holly Nibllet. In this article, the author discusses the advents in technology and how to control mobile screen time. How COVID-19 has changed our viewing habits, along with screentime data for children from the UK, is presented.
  2. Published in 2019 is another practical guideline Digital Guidelines: Promoting Healthy Technology Use for Children by the American Psychological Association.
  3. The American Academy of Pediatrics has established recommendations for children’s media use. Their current recommendations advise:
    • For children under 18 months, avoid screen-based media except video chatting.
    • For children 18 months to 24 months, parents should choose high-quality programming and watch with their children.
    • For children 2 to 5, limit screentime to one hour per day of high-quality programming.
    • For children 6 and up, establish consistent limits on the time spent using media and the types of media.
  4. A documentary worth watching is by Carlota Nelson, director of the documentary Brain Matters, which explores why too much screentime can harm babies and the importance of ensuring children enjoy off-screen experiences. Also, check out her engaging interview on the thinking behind this film.

Health communication fatigue looms large

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Screenshot 2023-03-24 at 15.12.55

Over-communicating health- can it ever be counterproductive?

We seem to be over-communicating health in the aftermath of COVID-19 and now run the risk of making our communication ineffective the next time a health emergency arises. The miracle of antibiotics, when prescribed appropriately, is best known to the patient whose condition starts improving quickly. However, this does not mean antibiotics are the solution to every illness. If given indiscriminately, the damage can be vast and irreversible. Similar is the case with health communication.

The risk of communication fatigue

While the pandemic showed the necessity of public health communication, it may now be causing communication fatigue among the public. It is essential to review the frequency and volume of health communication. COVID-19 taught governments, health organisations, and public health professionals how to communicate complicated scientific knowledge to the public in an understandable and actionable manner.

In the public interest, centre stage was provided to the World Health Organisation (WHO) to be the lead UN spokesperson on COVID-19. The UN Secretary-General showed admirable discipline in ensuring that Dr Tedros, the Director General of the WHO, leads the UN in critical communication during the pandemic. Health has been at the heart of every important policy debate over the last two years. The audience’s attention gained on the importance of human and animal health can be easily lost if strategic choices are now not made on how much to communicate and what to communicate on health.

In 2020, WHO coined the word Infodemic to describe an outbreak of information, disinformation, rumours, and fake news. Now it seems critical that international health actors do not turn into perpetrators of Infodemics, especially in the context of countries.

Endless marking of health days- risk of losing public trust and credibility

In February, health agencies marked World Cancer Day, International Day of Zero Tolerance for Female Genital Mutilation, International Day of Women and Girls in Science, International Epilepsy Day, and Congenital Heart Defect Awareness Day. Similarly, in March, the impressive line-up is International Women’s Day, World Kidney Day, World Oral Health Day, and World Tuberculosis (TB) Day. And in April, we will mark World Health Day, World Malaria Day, World Immunization Week and World Day for Safety and Health at Work.

The point is that for each of these special days, we see events being organised with elaborate ceremonies, the printing of banners, posters, selfie stands, speeches, t-shirts, standees and most troubling- an avalanche of social media posts with reminders on the importance of whatever is being celebrated. This country level health-Infodemic which I call “HelDemic”, is not limited to the digital space but is also sucking up the valuable time of policymakers and health workers and generating tons of plastic waste.

A lack of interest and compliance is one of the critical concerns of communication fatigue in public health communication. When people are continually bombarded with a lot of information and messaging, they may get desensitised and tune it out. This might lead to a lack of incentive to adopt healthy behaviours or follow public health norms, perhaps increasing disease spread.

Corrective action and celebration triage is needed urgently!

Disease burden and national strategic plans should guide the choice of three to five health days to mark in a year. An uninterrupted barrage of visuals of inaugurations, closing ceremonies and speechmakers on social media is not the best health communication investment and risks reducing the credibility of those seen engaging in this. Effective communication strategies, such as using a variety of communication channels and formats, can help prevent communication fatigue and promote healthy behaviours. Choosing to tone down communication and spacing is also a wise strategy.

Between the devil and the deep sea- tough choices for the poor

This is easier said than done, especially in countries that rely heavily on foreign aid to fund critical services like healthcare. Public employees in these countries are often needed to attend meetings and such events with international donors to seek financing, manage projects, and report on progress. While working with international donors is vital to get funding and promote development programs, there are significant risks involved with public officials becoming overly focused and exposed to ceremonial roles and not being seen in critical policymaking.

Post-COVID-19, the way countries have rolled back special measures like mandatory mask usage, pre-departure forms, and media briefings, it is time to tone down public health communication. The audience needs a breather. There is an urgent need to shift to strategic health communication to achieve focused public health objectives. This approach requires a deep understanding of the local context, the target audience, and the social, cultural, and economic factors that impact health behaviours. Unfortunately, most international health actors are in shortage of talent with the capacity to do this. Worse is the fear that they may not see this need until the next health emergency knocks at our doors.

Time to cut down the noise and deliver solid results!

The globe is falling short of meeting the targets for the health-related Sustainable Development Goals 2030. However, if governments are to meet these targets, they must prioritize policies and execution while reducing general health communication surrounding health days, events, and celebrations. It’s time to turn down the volume and avoid health communication burnout!

Published in The Himalayan Times, Thursday, 16th March 2023. Page 4.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Public Health debates we can ignore at our own peril

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public health

Global lessons learnt are not as valuable as we might think!

Having lived and worked in low-, middle- and high-income countries, I do not like sweeping ‘global lessons learnt’. The situational, cultural, and operational contexts based on countries’ income levels vary hugely. Moreover, the reports and recommendations from global apex bodies are often drafted by people from primarily high-income country experiences. Many of them may have never actually worked at the country level. Often their lexica are so watered down in assessments of low-income countries that severe reprimand ends up sounding like applause by publication. Without a scorecard system where each country would know where they need to improve to achieve standards, it is difficult to get a reality check. We, the low-income countries, have a choice to make. We can believe that we are high performers or quench our vanity, critically examine our performance, and take corrective measures.

The glaring gaps in public health that COVID-19 exposed

COVID-19 has exposed critical societal gaps across the globe. In the case of high-income-developed democracies, this means adjustments and fine-tuning. In the case of low-income countries, this has meant seeing a horrid picture in the mirror and the need for transformational change. So a natural enquiry would be-what has been happening in the business of Health Systems Strengthening over the years and billions of donated dollars later? We would have thought that SARS, Ebola, MERS, and ZIKA emergencies would have better prepared our health systems, but here we are.

This pandemic has opened some chronic societal wounds, especially in low-income countries. The top issue that warrants an urgent societal debate is what services are essential and must remain in the public domain and how we regulate the private sector. Many proponents for the rapid privatisation of public services in low-income countries are foreign experts. Their countries have achieved an equilibrium between top-notch public services and effective private-sector regulation.

Public Health, Corruption & Transparency

Corruption, lack of transparency, power asymmetry, and invisibility of women in decision-making all contribute to the complexity of public versus private debate in low-income countries. When lawmakers overtly or by proxy own significant numbers of private hospitals, mainstream media, and educational institutions, it becomes difficult to have an objective national debate. The COVID-19 pandemic has allowed us to rethink and reboot societal contracts. The pandemic struck when public trust in institutions- governmental, civil society, private sector, media, academia, and the judiciary was at the lowest after years of steady decline globally.

Public sector- the saviour during COVID-19

Suppose we reflect on the past two years of the pandemic in low-income countries. In that case, we will note that we turned to either the public sector organisation or the defence forces whenever we needed a timely nationwide response. For example, when students needed to be brought back from abroad in India, the then-national carrier Air India stepped up. When stranded migrant workers needed to return home, it was the Indian Railways that rose to the occasion. When liquid oxygen had to be mobilised, the public sector was at work again. Working around the clock to secure scarce supplies from other countries and securing evacuation permissions were diplomats who are public servants. On the borders, facilitating the movement of people, supporting testing, quarantine etc., were members of the border police, armed forces, and the police. Similar was the case with many countries in South and Southeast Asia.

Other rich countries, such as Germany and South Korea, responded robustly. Attribution to the ability of their governments to manage private-sector activity and essentially public ownership of critical health system elements. Their impressive testing capacity was thanks to public laboratories and the presence of industries that could supply the required safety equipment and chemicals.

The South and Southeast Asia neighbourhood

Some governments in Southeast Asia have managed to build public health systems that learn. So, lessons from SARS and Tsunami have fed into their preparedness systems, allowing them to respond efficiently and effectively. The city-state of Singapore has traditionally shown a proactive approach based on solid scenario planning and proactive public health communication. Within India, the response of the southern state of Kerala has stood out. Over the decades, Kerala has invested in health, education, and women’s empowerment. It has consistently adopted an evidence-based approach to decision-making on health matters. Theirs is a learning system that drew heavily on lessons from the NIPAH virus emergency not too long ago. Kerala has also avoided the black-and-white notion of Public or Private and established a successful public-private partnership model. The government of Vietnam efficiently diagnosed the regional situation and closed its borders. Similarly, they were swift in developing low-cost test kits.

Public Health and the private vs public discourse- an axis of national security too

The considerations that need to be at the centre of this post-COVID-19 public-private discourse are:

  • Re-evaluate and reign in the privatisation spree of health-related assets and services. Nurture back to health underperforming units through quick and transparent reform.
  • Two, Reboot and relaunch sensible and practical national health policies that serve the objective of achieving universal health coverage. These should not be a copy-paste of what middle- or high-income countries are doing but should be rooted in the realities of poverty, patriarchy, and emerging democracy.
  • Three, While the issue may appear to be of health, the scope of solution searching is well beyond the expertise or experience of health actors. The complexity of this matter warrants the leadership of the Ministries of Finance, Law, Commerce and Home. For example, supply chains, the rule of law during the lockdown, transportation of people, and labour issues related to health workers have solutions outside of health agencies’ remit.
  • Four, Governments must take the lead and regulate the private sector more effectively and transparently. While governing the somewhat more streamlined public sector may be more satisfying, the rapidly and wildly growing private sector needs aggressive regulation. In many low-income countries, this means enforcing the existing fantastic on-paper rules and not drafting new ones. Moreover, the hopelessness of data collection from private sector health providers, whether on testing, bed occupancy, oxygen availability, or mortality during COVID-19, has hampered many low-income countries’ effective and timely response.

Refocusing on the Health for All agenda

This public discourse requires us to open our eyes to what we witnessed in the last two years and set aside our ambition and vanity. Let us acknowledge the actual situation in our countries and not artificially push ourselves into a higher boxing category for mere prestige. Organic, home-grown solutions are needed now, not a collage of random international best practices. Instead of drawing lessons from countries in the region, we need to study states and provinces with similar challenges and partner with them. Cross-border areas should be of interest in standard solution searching.

Many glorious careers are built worldwide in the name of Health Systems Strengthening. However, COVID-19 has shown that not much strengthening may have happened. WHO’s “Health for All” agenda ought to remain our focus. However, the tools, processes and commitment need to be indigenous. Countries must bring their sharpest, most independent, and most fearless minds to this debate.

Let us not forget that health, education, and security are nation-building tools. Taxpayers will have little incentive to contribute their fair share if all these continue being disproportionately privatised. One can only imagine the threat to democracy this will pose.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Published in Nepal’s national daily Kantipur on 30 June 2022 in Nepali language. This is a translation with some additional text.

An urgent and critical re-think of global health governance and mandates is warranted!

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Dr Sunoor Verma’s interview Face to Face with The Himalayan Times. Published on 22nd April 2022

Global Health governance, COVID-19

The Himalayan Times (THT) Question: In an interview with THT in March 2020, your predictions on how COVID-19 will play out came true. So, what has changed in the global health business in these two years?

Dr Sunoor: It seems to me that COVID-19 has shown countries, policymakers, technocrats, businesspersons, and the media the mirror. And the picture in the mirror was far from pretty. Years of under-investment in health as public service and health professionals have brought us to despair. We also saw that when there is strong cooperation between high-income countries and multilateral agencies like WHO, there can be accelerated solution-finding, as with vaccine development. At the same time, we saw that not much has changed on the axis- rich and poor. The rich controlled the allocation of essential Covid19 supplies. The helplessness of the poor, both as individuals and as countries and their dependency on acts of charity by rich countries is one strong memory of the last two years. I believe that what has also changed over the previous two years is the frivolous questioning of WHO‘s relevance. The UN’s health agency has long been the favourite punching bag of health stakeholders. With all the shortcomings of any membership organisation, WHO has shown that it is more than a normative and standards body. Its power of convening health actors has been hugely visible and effective these past two COVID-19 years. Low-income countries often vent on UN agencies for their miseries, especially the WHO. This is because they cannot box donor countries as they welcome the bilateral money that flows from them. Many member states ask WHO to be stronger, wiser, braver, etc. They must realise that WHO is the sum of the strength of its member states. Low-income countries can only contribute to WHO’s strengthening by making their health systems solid and practical for the commoner. All said and done; global health governance needs a rethink and recalibration. India, Brazil, Thailand and many others who until now were regarded at the periphery of global health governance architecture have unequivocally demonstrated their strength.

THT: What are the lessons for low-income countries from the last two years of COVID-19?

Dr Sunoor: Negotiation from a position of poverty is a non-starter. Least so during a global health crisis. While globalisation has been much celebrated, the poor have not benefitted proportionately. I hope that developing countries learn that health must transcend nationalism and regional alliances must be made as disease crosses borders quickly. Instead of each country reinventing institutions, regional health resources must be shared. They should be recognised and shared regionally by setting up laboratories, training facilities, stockpiling drug testing, and registration. It is a pity that regional fora such as SAARC have not developed to their potential and around the topic of health remain rudderless. Once again, with the facilitation of bodies like WHO, there was support for utilising the capacities of member states during COVID-19. However, these should be a reflex of countries and not the cajoling of international bodies. Regional global health alliances need to be forged now. These need to be regional in operations and financing yet learning from global systems.

Another vital lesson is the importance of activating existing emergency and disaster mechanisms over inventing new structures on the go. Some countries learned that emergencies are not the best time for adventure but rather for tested mechanisms.

THT: As you work closely with leaders and elected officials on strategy and leadership communication around the globe, what lessons are there from COVID-19 for leaders?

Dr Sunoor: COVID-19 has shown the importance of leaders exercising leadership. Occupying a leadership position is no guarantee of leadership. There is ample evidence and peer-reviewed research that countries where women have been in leadership positions on COVID-19, have fared better in their response. Power asymmetry against women in our countries in South Asia is a barrier to our emergency response, development, and prosperity. Excluding women from top-tier decision-making has been a blunder that should be corrected for future emergencies. An important message for leaders is that excluding women from decision-making is foolish and expensive. Donors should make grants available only subject to at least a fifty per cent representation of women in the steering committees of any project they fund in recipient countries.

Second, leaders have seen that undisciplined, unplanned, and unverified communication during health crises leads to the death of people. Third, communicating science and scientific messages to a broad and diverse audience is challenging and beyond the scope of many politicians and leaders. Either they should follow advice and scripts prepared by experts or appoint their own “Faucis” and let them do their job without interference. The top communicators on COVID-19 among leaders have been the former Chancellor of Germany and the Prime Minister of New Zealand. While Mrs Angela Merkel, a scientist, simplified complex data for her citizens in direct telecasts, Ms Jacinda Ardern showed unprecedented transparency in decision-making. If you don’t understand science, don’t deny it or twist it but appoint experts to communicate it and let them do their job.

Another lesson for leaders, I hope, is that they must be unifiers and not dividers in crisis. When people suffer, the last thing they want to see is their leaders’ bickering. The ability to transcend petty politics and create an environment of a unified national response is critical. Unfortunately, few leaders around the world have achieved this feat during COVID-19.

THT: In the post, COVID-19 world order, are multilateral agencies like WHO still relevant? Does their role need to evolve?

Dr Sunoor: Close your eyes for thirty seconds and visualize COVID-19 without WHO.

The question of relevance arises only if there is an alternative. In a world divided along the axis of income, gender, faith, ethnicity etc., the importance of a convener and facilitator is critical. WHO has outstandingly supported countries in their COVID-19 response, especially for an underfunded organisation. Do such agencies need to evolve or transform? Yes, of course, we all need to evolve constantly. High-income countries that fund much of the budget of WHO should want a transformed organisation and support that journey consistently and systematically. Low-income countries should better appreciate the rich-poor power asymmetry more realistically and temper their expectations accordingly.

I also feel that a new kind of expertise is needed in the global health arena. While countries need the norms and standards-setting from an apex body; however, their country-level implementation requires more than technical expertise. It requires coalition-building and diplomacy talent to help countries navigate their factions and mazes. Twenty years ago, people expected disease elimination from WHO; today, they expect WHO also to deliver health and well-being. This warrants an ability to look beyond WHO’s traditional matrimony to government health agencies and forge partnerships with national finance, policy planning, youth, education, and technology custodians. Finally, for any international agency, it is crucial to set clear criteria on when to exit a country, announce it, and adhere to that handover. How many flags you can pin on the world map should not matter in a Zoom world.

THT: Lastly, what conversations are essential now, drawing from the COVID-19 experiences as a society or global community?

Dr Sunoor: A core question that societies need to debate is what should remain in the public sphere and what in private? We have seen that countries with a robust public system of services have done much better in their emergency COVID-19 response. This is an important question, especially for low- and middle-income countries with an urgency to privatise public institutions and services in a call for greater efficiency. Some countries that advocate privatisation in aid-recipient countries have maintained solid public service systems in their own countries. So, this needs to be an organic debate in situ.

At the citizen level, I hope we will appreciate that Health is Politics. Voters would need to demand of their politicians the fundamental right to good quality health, education, and nutrition. And hopefully, this is what the ballot would be cast on in future.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

The WHO is not our nanny!

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Published in The Himalayan Times on 2nd April 2020

WHO, World Health Organisation

Is WHO our global health nanny?

Expecting the World Health Organisation (WHO) to be our universal nanny is unrealistic and dangerous, especially in times of crisis. WHO is a body that brings together global expertise, health intelligence and experience to all its member states. Every organisation essentially represents the nature of its membership and what its members want it to be. WHO is made by your governments. Countries must take WHO’s guidance as their core ‘plan minimum’ and add to it their wisdom.

Imagine the COVID-19 response without the WHO

Gripped by COVID-19, all eyes are on WHO for guidance on what to do and what not to do? All it takes is to imagine our response to the pandemic without the WHO. All said and done common perception is that this is an organisation owned by member states and would be the closest that we could get to neutral information. Many criticise WHO for being influenced by one powerful state or another. However, no one has developed an alternative body that would enjoy the reach or brand recognition of WHO while maintaining the entire range of health expertise from epidemics to road injuries. Governments quote the WHO, and follow its guidance and feedback data into it.  The network of collaborative centres that the WHO operates in partnerships with academia and government is an immense asset to the global pool of knowledge and capacity.

What started as a health crisis has very rapidly evolved into a societal crisis. Some countries have declared COVID-19 a national security crisis, some have termed it a national disaster, and others have termed it a war. It is essential in this context to understand the role of the WHO, lower our expectations of it and shift specific tasks and responsibilities to other actors.

Shift expectations away from WHO to other agencies

While the WHO teams around the globe churn out a range of information material on how to deal with COVID19, other actors need to take that information forward to their constituents. Take, for example, the WHO‘s social distancing guidelines. These ought to be taken up by organisations within countries, modified to the local context, translated into the local languages and amplified using channels that work best in that given context. Marinating in inaction, awaiting tailor-made guidance for every population segment for every country is a luxury we can not afford now. In the country context, line ministries need to step up their game and use their intelligence to customise the science coming out of the WHO and channel it to their captive audiences. Spoon-feeding is not an option in times of crisis. Similar to the WHO, as Ministries of Health are overwhelmed in responding to the COVID19, line ministries should not self-paralyse for lack of vetting of each communication piece from their Ministry of Health counterparts. There is neither time nor any human resources that can be spared for this. In multiplying and amplifying messages, mistakes might be made here and there, but they can be corrected. The risk of doing nothing is way higher than making a few mistakes.

Help WHO deliver on its core mandate

Every emergency coordination meeting I have attended at a country, regional or headquarters level invariably ends with one default recommendation- we must coordinate better. Pick any emergency response evaluation, and you will see the same outcome. While coordination during a crisis may hold some limited promise within sectors- e.g. UN country teams, International NGOs, and government ministries, it rarely works between industries. It is no different from how things function or don’t within a building of tenants or extended family- some will always go solo or only halfheartedly implement agreements. I have found this to be valid as emergencies draw out. In a COVID-19 global crisis, let us allow WHO to focus on giving the world its best technical intelligence and advice.  Let us not put it under the expectation of global babysitting. It is the time to encourage all other ministries, organisations, industrial bodies, and associations to study, digest and use the WHO‘s knowledge and advance it to their audiences as quickly as possible using their innate intelligence and experience.

Let us help the WHO focus on its core knowledge generation and dissemination business. It is time for each of us to step up to our duty of using WHO‘s output responsibly and proactively in beating the menace of COVID19.

About the Author

Dr Sunoor Verma is a former Cardiothoracic surgeon; his experience ranges from various emergency settings related to the Avian Flu, SARS, Tsunami, HIV/AIDS, Kosovo crisis, Macedonia armed conflict and the Sri Lanka conflict. His focus is Strategy, Risk and Crisis Communication and Strategic Partnerships in international development. He has advised WHO, UNICEF UNHCR, the European Centre for Minority Issues, Cambridge University, Boston University and the Hospitals of the University of Geneva. He balances his high-level policy work with advisory work to grassroots NGOs worldwide. He works out of the Lake Geneva region.

Collective action needed to exit from COVID-19 crisis

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COVID-19, Sunoor Verma, Nepal,

What should the roles of government, private sector and the general public be in terms of crisis communication?

Crisis communication is very different from regular communication. This is because the way people perceive threat, process information and react to information is very different from that of the regular scenario.

The other challenge we face in the globally connected media is that we are watching what is happening in developed countries. Suddenly our own expectations from our own governments become unrealistically high. But we have to realise our own context and manage our expectations in that context.

Governments need to see that people expect information quickly to make themselves and their close ones safe. Second, they want reliable information. Third, they want information they can turn into action for themselves so that they can take their safety into their own hands.

The people need reliable information from governments, and governments need collaboration and cooperation from the people. These two elements need to be in harmony. For that to happen, there needs to be a single source of information that is trusted. In the case of this epidemic, the official government mechanism and the World Health Organisation are the only two sources from where we take the information.

Then there’s the role of leaders in other sectors. Leaders do not only mean elected leaders. We are looking at leadership from all sectors — within the private sector, the faith sector, and within the community sector.

For example, if I am a shopkeeper in Kathmandu, I should not expect the government or WHO to come up with a protocol on how to maintain social distancing at the shop. Shopkeepers, or their associations, should decide how we manage social distancing at shops.

Also, videos on how to wash hands from developed countries show people washing their hands for 30 seconds under running water. Where do we get running water in Nepal? Our reality is a mug of water. We need a video on how to wash our hands with a mug of water for 30 seconds. This is not something we expect the government or the WHO to come up with. There are so many creators, YouTube stars and influencers. They can make their 30-second video.

It should be clear there’s no individual exit from this. The only way we can exit from this is through collective action. So this is the first time, I think, we are facing a crisis where it does not matter whether you are rich or poor; literate or illiterate; male or female; Hindu or Muslim or Buddhist.

Your survival depends on your neighbour. This is a massive equaliser. So crisis communication needs to be mastered very quickly by leaders in all spheres of life.

How can the private sector, which has yet to come out in Nepal, address this crisis?

It is very important for the private sector to step up to see what the government is doing and immediately come up with offers of action and support. This is not the time to negotiate product placement, visibility, brand logo, etc. This is the time for the private sector to unite most effectively through their associations. That way, the interests are not competing within companies or brands. It’s an industry coming together.

For example, an industry of manufacturers comes together. See what the government is doing. See what the messaging is and think about how they can take the message forward into areas they influence. How they can multiply and amplify the message and make it more understandable for their constituents. They must also start thinking of scenarios in future planning. At the moment, we are all thinking about the crisis. We are not thinking after the crisis.

When the private sector starts helping out, the government will also probably ask the private sector for things they could do. For example, Airbus and Rolls Royce are presently not manufacturing aeroplanes or engines, but they are manufacturing ventilators.

Everywhere in the world, countries are following one model of lockdown to slow down the spread of novel coronavirus. How sustainable is that model, especially for a country like Nepal where people have to go out to work every day to eke out a living?

This is where multilateralism comes in. Countries, no matter how independent and how proud, this crisis reminds us we are not independent but we are interdependent. So when we are interdependent, we have to use each other’s strengths to understand who is working how and resolving the problems through which means, and pick from there.

This is where multilateralism, regionalism, regional cooperation all come in. You can see China has sent a medical team to Italy. Cuba has just sent 50 doctors to Italy as well. So we need to see our partners who can help us in what manner. And help is not just with financial aid but with ideas. We also have to realise that solutions will emerge as we move on.

The other thing that we should ask ourselves is what the other option to the model of lockdown there is. Let’s start with the one option we’ve seen working everywhere until we have another option. In the meantime, we develop solutions as they emerge or as the problem evolves. But I do not think we have the luxury of waiting.

Is this crisis forcing everybody, even those writing off multilateralism, to rethink it?

Multilateralism is criticised because it is a soft and favourite punching bag for everyone. Any organisation, in essence, reflects the members it has. The United Nations is what its members are and what its members want it to be. But it is an easy punching bag because it is not easy for a country to go and punch an individual member which is more affluent, bigger and more powerful. But the COVID-19 crisis is reminding us about the importance of the WHO with its vast networks of collaborators of laboratories around the world, sharing information, pooling data and working 24 hours a day. If this system of multilateralism was not there, you would not have the WHO. Then the question would be, whose information would you trust? Of course, the UN system has to reflect modern society. But it is very big, and it takes time to change. Member states have to also think about it.

You have the luxury of so many UN agencies in Nepal. These agencies have programmes around the countries. So here you have channels and expertise spread around the country from a multilateral organisation where you are a member, where you can demand help. The UN offices are open, and all the heads of the UN agencies are in their offices.

How do you think this crisis is going to end as people paint a gloomy picture?

This whole experience poses questions on how we function as a society and in governance. So people and governments have a choice — will they make decisions based on scientific evidence? The second choice is whether we are going to support the public health sector or not. You can see the delay in response to COVID-19 in the US is attributed by many to reduced funding of the public health sector in the last few years.

In terms of the gloomy picture, science tells us virus evolves. The whole idea of the lockdown is to delay how the virus moves from one person to another. Hopefully, several parameters will change until we manage to postpone this, such as heat and humidity and hopefully, infections go down. So I think the evolution would gradually become that of the flu. It might re-emerge in November or December when seasonal flu occurs, but most scientists feel the virus would have evolved or mutated by then. But I think we do not have the luxury of long-term scenario planning in a crisis like this. We need to start step by step based on the experience that is evident around us. China has managed to bring it under control, South Korea is doing quite well, and Taiwan and Singapore have done quite well.

If you look at countries that have done well, they have been very strong in crisis communication and supply chain management. I think many of these countries have outstanding relations with Nepal. I think the way forward is to seek their expertise and support. Nepal is a full-fledged member of the United Nations. There’s immense recognition of Nepal’s contribution to the peacekeeping forces. Nepal has helped the world. Now Nepal needs help; I think the world will stand to support Nepal.

About the Author

Sunoor Verma is a senior international development specialist in strategic planning, strategic and risk communications and strategic partnerships. His experience includes advisory work for the World Health Organisation, UNHCR, UNICEF, European Centre for Minority Issues, Cambridge University, University of Geneva and Boston University. Most recently, he consulted WHO-Geneva on developing their Risk Communication Strategy for Pandemic influenza.

Roshan S Nepal of The Himalayan Times caught up with Dr Sunoor to talk about the importance of crisis communication in this time of COVID-19 pandemic. Published on 24th March 2020 in The Himalayan Times English national daily newspaper Nepal.