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ADB Review 36.3 MDG FA.p65



The Millennium
Development Goals
Will Asia and the Pacific
Achieve Them?

                                          June 2004                  1
     Volume 36, Number 3
     June 2004

     HER FUTURE ADB is well placed to
     continue its role as a valuable global

                                                                                                                                                                         Richie Abrina
     partner in helping developing member
     countries achieve the MDGs by 2015

MILLENNIUM DEVELOPMENT GOALS                                                      26 HEALTH Good                                        32 Thirst for Change
    6 OVERVIEW Staying on Track for 2015 While                                       Health Begins at                                        In 1993 the people of
     not new for ADB, the MDGs represent shared, measurable,                         Home Battling ingrained                                 Phnom Penh lacked a
     and monitorable goals that DMCs are seeking to achieve in                                      and unhealthy lifestyles                 reliable water supply but
     partnership with ADB                                                                           through community                        all that has changed
                                                                                                    partnerships with the health
    8 ANTICORRUPTION A Black and White Issue                                                        establishmentis helping             34 Fatal Attraction
     Corruption in Asia and the Pacific is often obscured by                                        lower maternal and infant                Steps to counter the spread
     a haze of secrecy and is difficult to measure                                                  mortality rates, and reduce              of HIV/AIDS are showing
                                                                                                    disease levels in rural                  results in the Greater
                                                                                                    Indonesia                                Mekong Subregion
12 NUTRITION Rice Power Trials to gauge the
     effectiveness of boosting the iron content of rice are
                                                                                     Graham Dwyer

     showing encouraging results that could drastically
     decrease micronutrient deficiencies

14 RURAL DEVELOPMENT A Time for Change
     Learning innovative ways to manage their environment
     has created new opportunities for poor rural dwellers in
     Fujian Province in the People’s Republic of China

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

Realistic, Possible?
Local partnership, harmonization, and commitment all critical for success
By Graham Dwyer

External Relations Specialist                                                                       How does the Millennium Campaign
                                                                                                    and your work as UN Special Ambassa-
            rna Witoelar, the former Indonesian Minis-                                              dor for the MDGs fit within the con-
            ter for Settlements and Regional Infrastruc-                                            text of the UN system, and what does
            ture, was named the first United Nations                                                your work entail?
            (UN) Special Ambassador for the Millennium                                              Within the UN system there are two main
            Development Goals (MDGs) for Asia and the                                               supporting efforts to enable countries to
Pacific in September 2003. UN Secretary-General Kofi                                                reach the MDGs. One is the Millennium
Annan expressed the hope that her “talent and pres-                                                 Project, which is helping develop the right
ence as part of the MDG Campaign will contribute to                                                 policies to reach the goals—whether in eco-
reach the hearts and minds of people around the                                                     nomics, trade, or development. The other
                                                                                       Eric Sales

world.”                                                                                             is the Millennium Campaign, which is
   During a visit to ADB, she outlined in an interview                                              facilitating campaigns to make sure that
                                                           Erna Witoelar
for ADB Review the challenges ahead for the Millen-                                                 the process is catalyzed. Both units are di-
                                                           UN Special Ambassador
nium Campaign, launched in November 2002 to build          for the MDGs for Asia and                rectly under the Secretary General.
partnerships with stakeholders to mobilize support for     the Pacific                                  This is a new global solidarity momen-
achieving the MDGs.                                                                                 tum that must go beyond government to

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

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

                                                                                                                                         Ram Cabrera
velopment, and education.
    Many countries actually have money

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

4                    June 2004
                                                                                                              THE          INTERVIEW

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

How would you like to see ADB involv-
ing itself more in the MDG agenda?
ADB should readjust its existing programs
and existing approaches to better answer
individual countries’ needs in reaching the
MDGs. It also needs to gradually move
from direct local-level project intervention
to more strengthening of national and pro-
vincial capacity to develop and really
implement pro-poor policies because that
is our weakness.
                                               Rollie del Rosario

    ADB has a lot of knowledge generated                                                                               SHARED TASK Poverty exists at the
over many decades. We could make more                                                                                  local level, and it is at this level
use of this. Our national governments need                                                                             that the MDGs can be achieved
to be educated on good practices. There is

                                                                                                                                          June 2004      5

While not new for ADB, the MDGs represent shared,
measurable, and monitorable goals that DMCs are
seeking to achieve in partnership with ADB
By Bruce Purdue                                  Global Benchmarks

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

by 2015. ADB also understands it must aim
to better mainstream MDGs in policies
and actions, and help build consensus on
MDG priorities with our DMCs. We must
also aim for better consistency in how our
                                                        The MDGs represent a fundamentally important
                                                   global consensus on the key steps that must be taken to
country strategies and programs address            seriously tackle poverty and its attendant evils
the MDGs.

6                      June 2004
                                                                                                          dicators reflecting the MDGs and related

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

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

Consultant Writer                                  Goals. Because corruption
                                                   robs funds from programs
                    eciding what is corruption     to improve health, educa-
                    is more art than science:      tion, and other basic ser-
                    many people may find it        vices, the poor too often
                    difficult to define it ex-     pay the price. The World
                    actly, but they know it when   Bank Institute estimates
they see it.                                       that child mortality can
    Graft, fraud, nepotism, and bribery have       fall as much as 75% when
been around for an eternity. In individual         countries tackle corrup-
cases they can even appear to be benefi-           tion and improve their rule
cial. Far from suggesting smooth operation,        of law.
however, widespread corruption is a symp-              “While one may think
tom of malfunction that can hinder foreign         of examples in which some
investment and restrict development.               firms/people are made bet-
    “Rampant corruption demonstrates               ter off by paying a bribe...
that the system is broken—resources are            the overall effect of corrup-
not going where they should go,” says              tion on economic develop-
Michael Stevens, ADB Principal Audit               ment is negative. This is
Specialist, Office of the Auditor General.         just as true in Asia as else-
                                                                                   ADB file

     It is estimated that one third of public      where,” writes Shang-Jen
investment in many Asia and Pacific coun-          Wei, the Harvard-based
tries is squandered on corruption. Keeping         economist in a study of
in mind the difficulty of measurement,             corruption published in
                                                                                              More than $1 trillion is paid in
ADB officials suggest it can cost as much          1998.                                      bribes each year    World Bank Institute estimate
as one sixth of a country’s potential gross
domestic product.                                  Reducing Harm                                          Director of ADB’s Governance and Regional
    In a new study, the World Bank Insti-          Reducing corruption to less damaging                   Cooperation Division. Just how long it
tute estimates more than $1 trillion is paid       levels is difficult and can take a long time.          takes, he says, will depend on setting up
in bribes each year. Daniel Kaufmann, the          It requires leadership, the setting up of              an “environment for change.”
Institute’s director for governance, says the      independent watchdogs, establishment of                    The ADB-Organisation for Economic
figure estimates bribes paid worldwide in          policies and laws that are adhered to, and             Co-operation and Development (OECD)
both rich and developing countries. It does        public sector reform.                                  Anticorruption Initiative, started in 1999
not include embezzlement of public funds               “You will need many generations to deal            in response to the turmoil set off by the
or theft of public assets.                         with the problem. Things are bad, and some             Asian financial crisis, is helping set a tone
     The issue goes to the heart of the Mil-       are saying ‘getting worse’,” says Jak Jabes,           for change. Under this initiative, 21 coun-

8                        June 2004

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

                                                                                                  Richie Abrina
veys that gauge expert opinion, sometimes              Abuse of power for personal benefit
that of businesspeople. It is their percep-       will likely always exist. Recent high-profile

tion that matters, because they will decide       cases of corruption in Canada and the
where to invest their money in the region.        United States show
    Transparency International, an interna-       it is not just develop-
tional nongovernment organization that
brings civil society, business, and govern-
ments together to combat corruption, pro-
                                                  ing countries that suf-
                                                  fer from the problem,
                                                  nor is it culturally
                                                                                        Rampant corruption demonstrates
                                                                               that the system is broken—resources are
                                                                               not going where they should go
vides respected assessments of corruption         specific.
around the world. Through its International            “ We won’t fool             Michael Stevens, ADB Principal Audit Specialist

Secretariat and more than 85 national chap-       ourselves into think-
ters, Transparency International works to         ing we will get rid of it completely. It is
raise awareness of the damaging effects of        everywhere,” says Mr. Stevens.
corruption, advocates policy reform, works             The question becomes one of how to
toward the implementation of multilat-            work in a system where it is widespread,
eral conventions, and monitors compliance         and how to reduce it.
by governments, corporations, and banks.
    Its last perceptions index ranked
Singapore the fifth least corrupt country
                                                  How ADB Deals with Corruption
                                                  “People ask: why are you working with no-
                                                                                                                  1 Poverty and Hunger
in its list of 133. Hong Kong, China, was
14th, and Malaysia 37th. Bangladesh was
                                                  toriously corrupt countries? By engaging
                                                  with a country and providing a loan or tech-                    2 Education
last, tailing Nigeria.
    Most Asian countries were in the bot-
                                                  nical assistance we have the opportunity
                                                  for policy dialogue and to bring the issue of                   3 Gender Equality
tom half of the index.                            corruption to the forefront of our discus-
    The need for measurement, however,            sion and maintain dialogue on the issue,”                       4 Child Mortality
can be taken too far. “It does not matter         says Mr. Jabes.
what specific percent or level someone has            ADB is helping countries set up corrup-                     5 Maternal Health
measured. The more important issue is             tion watchdogs, such as in Bangladesh and
whether there relatively is a little or a lot,”
says Mr. Stevens.
                                                  Indonesia. In Nepal, ADB assisted in set-
                                                  ting up the National Vigilance Center.
                                                                                                                  6 HIV/AIDS
    In Malaysia, corruption foes are increas-
ingly hopeful the new Prime Minister,
                                                  Through a $600,000 technical assistance
                                                  loan, the center is supporting the develop-
                                                                                                                  7 Environment
Abdullah Ahmad Badawi, will keep his
pledge to crack down on corruption. His
                                                  ment of technical auditing capacity within
                                                  the Government and the private sector,                          8 Global Partnership
                                                                                                                               June 2004   9
LAW              MATTERS

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

By Kamal Ahmad                                    institutional arrangements and priorities at
Counsel, Law and Policy Reform Unit,              national and global levels.

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

10                       June 2004
                                                                                                          at certain quota volumes.
                                                                                                              Often the products affected are those
                                                                                                          over which low- and middle-income coun-
                                                                                                          tries have a comparative advantage, such
                                                                                                          as textiles. For example, Bangladesh’s main
                                                                                                          export is ready-made garments. The indus-
                                                                                                          try employs almost two million women for
                                                                                                          whom there are limited alternative liveli-
                                                                                                          hood opportunities. The tariff charged by
                                                                                                          the United States on Bangladesh’s $2 bil-
                                                                                                          lion of mostly textile exports is higher than
                                                                                                          the tariff charged to France for its $30 bil-
                                                                                                          lion of exports. An international trade re-
                                                                                                          gime supportive of the MDGs ought to
                                                                                                          eliminate such distortions of trade.
                                                                                                              While the MDGs are universal, no single
                                                                                                          approach is likely to be effective every-
                                                                                                          where. Each country must develop its own
                                                                                                          framework for catalyzing diverse local pro-
                                                                                                          cesses that will ultimately yield the best
                                                                                                          results. The MDGs call for global priorities
                                                                                                          to be aligned in a way that can dramatically
                                                                                                          reduce the deprivation suffered by poor

                                                                                            Ram Cabrera
                                                                                                          people. However, the goals can only be
                                                                                                          achieved and sustained when the policies,
                                                                                                          laws, and institutions implicated in this ef-
                                                                                                          fort are also aligned to meet this challenge.
    While the MDGs are universal, no single                                                               Without such a holistic approach, risk exists
    approach is likely to be effective everywhere                                                         that targets set by the Millennium Declara-
                                                                                                          tion may be met without addressing the
aside reserved seats for women in national       land remains unregistered, rendering it                  structural issues that ultimately will deter-
and local governments. Bangladesh is also        unavailable as collateral for obtaining                  mine the durability of such success. Here
contemplating reintroducing such a mea-          credit. ADB has been collaborating with the              the stakes are indeed high.
sure for elections to the national parliament.   Government of Cambodia to establish a

Afghanistan’s new constitution envisages         legal system with respect to landownership
the reservation of seats for women.              and land rights, including access to credit
    Most of Asia’s poor depend on agricul-       by mortgaging land.
ture for their livelihood. Access to land and        ADB research has pioneered an inte-
landownership is critical to the economic        grated approach to insolvency and secured
empowerment of the rural poor. Without such      transaction law reform to ensure that insol-
access, the rural poor have difficulty gaining
credit at reasonable terms. An example of
                                                 vency reforms support secured lending and
                                                 contribute to a more predictable debtor-
                                                                                                           1 Poverty and Hunger
the consequences of this can be seen in the
case of bonded laborers in Pakistan, in the
                                                 creditor legal regime.
                                                     While changes in a nation’s domestic                  2 Education
province of Sindh, where landless sharecrop-
pers are caught in a vicious cycle that robs
                                                 policies, laws, and institutional norms are
                                                 crucial, changes in the global framework                  3 Gender Equality
them of their liberty.                           are also necessary. Trade and nontrade bar-
                                                 riers, particularly concerning agricultural               4 Child Mortality
Raising Awareness                                products, still challenge many developing
ADB assistance to the Government of              countries trying to break into the consumer               5 Maternal Health
Pakistan through a loan for the Sindh Rural      markets of high-income countries. Although
Development Project is helping address
the plight of bonded laborers by, among oth-
                                                 tariff structures are often favorable to de-
                                                 veloping countries, particularly under pref-
                                                                                                           6 HIV/AIDS
ers, raising legal awareness and indepen-
dent transaction monitoring of debts that
                                                 erential access arrangements, such as the
                                                 Generalized System of Preferences and the
                                                                                                           7 Environment
ultimately forces a laborer into a bonded
state. In Cambodia, much of the nation’s
                                                 European Union’s Everything but Arms ini-
                                                 tiative, tariffs for some products escalate               8 Global Partnership
                                                                                                                                       June 2004 11

By Lisa Studdert                                 than 35% of women aged 15–49 are iron          Rice to the Rescue

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

Trials to gauge the effectiveness of boosting the iron content of rice are showing
encouraging results that could drastically decrease micronutrient deficiencies

                                                                                                                                              Lingkod Sayo/IRRI

                                                                                                SUPPER FOR SCIENCE 300 religious sisters in
                                                                                                               SCIENCE 300 religious sisters in
                                                                                                11 convents around Manila are taking part
                                                                                                in a trial to determine the health benefits of
                                                                                                a new strain of iron-enriched rice

12                    June 2004
                                                                                                                                     H E A LT H

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

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

sumption of different rice varieties can be
carefully monitored.
    The sisters’ iron status as indicated by
hemoglobin and other biochemical indi-
cators of iron status was measured before
the trial began, halfway (4.5 months), and                         The same women who consumed the high-iron rice
at the conclusion (9 months). Women                                on average also increased their body iron by 10%
remaining—or newly—iron-deficient at
the end of the trial were given iron supple-                     The next step is to conduct trials on        ing the MDG Goal 4 on reducing child
ments to ensure this deficiency was quickly                  the effect and use of high-iron rice in a com-   mortality. For sustained, effective solu-
corrected.                                                   munity setting and look at the effect on         tions, a continuing, concerted effort is re-
    The trial concluded in September 2003                    children’s iron status. A study is planned       quired from a diverse range of people
and, so far, the analysis of data indicate                   in Bangladesh in 2004–2005.                      including plant breeders, nutritionists,
the results have been positive. Among the                        ADB’s involvement in this work started       multidisciplinary research teams, donors,
women who were iron-deficient but not yet                    in 2000 under the leadership of Joseph           and affected communities.
anemic at the start of the trial, total body                 Hunt, ADB Senior Health and Nutrition               The prospect of helping children reach
iron reserves improved significantly. The                    Specialist (now retired). Due to ADB’s           their full intellectual potential and
women who consumed the high-iron rice                        commitment to the concept of biofortified        women survive the most basic and impor-
ingested about 20% more iron per day than                    crops for improving the nutritional status       tant process of childbirth makes this effort
those who consumed the regular rice. The                     of the poor, there have been significant         more than worthwhile.

same women who consumed the high-iron                        developments in the field.
rice on average also increased their body                        In October 2003, the Bill and Melinda
iron by 10%, while the women consuming                       Gates Foundation committed $25 million
control rice actually lost 6% of their body                  to IFPRI’s HarvestPlus program that will
iron. The greatest increases in body iron                    work to develop crops with enhanced nu-
were seen in the women who consumed the                      trient status: not just with iron but also
most iron from biofortified rice.                            with vitamin A and zinc and in other key
    These are preliminary results and                        staple crops on which the poor around the         1 Poverty and Hunger
analysis is ongoing . The research team is                   world depend (wheat, maize, beans, cas-
preparing papers for submission to scien-
tific journals and results will be presented
                                                             sava, and sweet potato).
                                                                 Improving iron status in Asia’s poor
                                                                                                               4 Child Mortality
at conferences for discussion and delibera-
tion. Most importantly though—for ADB,
                                                             populations will directly serve global ef-
                                                             forts to meet the Millennium Develop-
                                                                                                               5 Maternal Health
IFPRI, and IRRI—they indicate that there
is good reason to keep pursuing this work.
                                                             ment Goal (MDG) 5 on improving
                                                             maternal health and contribute to achiev-         8 Global Partnership
                                                                                                                                          June 2004 13
Learning innovative ways                                                     FAST GROWER
                                                                             Ma bamboo is
to manage their environ-                                                     considered one of
                                                                             Yongchun County’s
ment has created new                                                         six major industries

opportunities for poor
rural dwellers in Fujian
Province in the People’s
Republic of China
By KyeongAe Choe and Carolyn Dedolph
Senior Project Specialist, and External Relations


              very time it rained, the farm-
              ers of Shi Gu Town in
              Yongchun County, Fujian Prov-
              ince in the People’s Republic
              of China (PRC), would watch
the sandy soil—and their livelihoods—
wash down the denuded hillsides. They had
difficulty eking a living out of their sloping
fields, which had suffered from years of poor
cropping practices.
    In 1996, the average annual household
income in the village was yuan (CNY)
1,800 ($220), with a third of the house-
holds earning less than CNY1,000 ($120).
However, a fast-growing variety of bamboo
(Dendocalumus latiflorus) has changed their
lives for the better. Known for its bountiful
shoot production, Ma bamboo has nearly
stopped the severe soil erosion and more
than doubled farmers’ incomes.
    Ma bamboo, which grows to about
13 meters, has many uses: its young shoots
can be eaten fresh or be canned, its stems
are processed into incense sticks and bam-
boo baskets, and its leaves are used as wrap-
pers. By the third year, 15–20 kilograms (kg)
of young shoots and 30 kg of poles may be
harvested from every clump.

                                                                      A TIME FOR
    “Bamboo is more profitable than other
crops,” says farmer Gao Wen Xi as he cuts
grass for green manure. Within two years of
planting the bamboo, he was selling the

shoots to a nearby canning facility and the
stems (poles) to a local pulp mill.
    He has invested some of his earnings
from the bamboo into rice, pigs, and an or-
ange orchard, increasing his family’s total
                                                    Carolyn Dedolph

income by CNY7,000–8,000 ($845–970)
a year. He and his wife have also used the
money to build a house and pay for their
two children’s education.

14                         June 2004
                                                                                RURAL                 DEVELOPMENT

Social Spin-Offs                                 Income generated by the project exceeded        Impressive Outcome
About 27 million of Fujian Province’s 34         the expected income by 20% (CNY6,928            According to PRC official estimates, be-
million people live in rural areas where the     [$835] annually per family in 1995 con-         tween 1998 and 2001 the soil conservation
terrain ranges from mountainous to hilly to      stant prices). Of the 64,000 or so partici-     and agriculture development component of
coastal. Arable land is limited, and what-       pating rural households, 35% were below         orchards, tea gardens, and bamboo planta-
ever suitable land is available is intensively   the poverty line in 1995; at completion,        tions produced 40,000 tons of fruit, 8,000
cultivated, causing soil degradation and         most had been lifted out of poverty.            tons of tea, and 50,000 tons of bamboo shoots
erosion. Since the start of economic reforms         Local government support was impor-         totaling CNY1,120 million ($135 million).
in 1978, economic growth in Fujian has been      tant in obtaining loans for private investors       About 5,800 ha of new orchards were
largely concentrated in urban areas, in-         from local banks. A risk-sharing mechanism      developed and 11,573 ha of existing or-
creasing the rural-urban gap.                    among the village farmers engaged in            chards rehabilitated (see story, p. 16). In the
    The Fujian Soil Conservation and Ru-         orchard development with good perform-          aquaculture component, about 90,000 tons
ral Development Project, with a $65 mil-         ing agro-business enterprises was one of the    of aquatic products were produced worth
lion loan from ADB and a $406,000 grant          key factors for strong partnership and          CNY1,200 million ($145 million) (see story,
from the Japan Special Fund, began in 1995       success. Providing innovative small             p. 17). Seven agro-processing facilities gen-
and was completed in 2001. Its main              shareholding opportunities and technical        erated more than CNY80 million ($9.6 mil-
objective was to promote sustainable             and management support from private             lion) in sales revenues and provided about
growth in the rural economy in ways that         business partners were also instrumental        700 permanent and 30,000 seasonal jobs.

benefited the poorest people.                    in helping achieve the highly successful        More than 19,000 training courses on con-

         Our goal is to serve the people and
                                                                   “            outcome of
                                                                                the project.
                                                                                Risk sharing
                                                                                                 tour terracing, fruit variety selection, soil
                                                                                                 conservation, and orchard management
                                                                                                 were conducted.
         alleviate poverty among our farmers                                    through di-          According to Fujian Vice-Governor Qiu
              Lin Kai Wang, Project Director and Senior Agronomist              rect parti-      Guang Zhong and provincial officials, the
                                                                                cipation,        Fujian project was successful because it had
    The project’s five components were partnership, and government cooperation                   strong commitment from the Government
linked by the common objective of promot- with the private sector in initiating rural            to make it work and ensure the agriculture,
ing soil conservation and rural develop- investments—and the eventual phaseout                   finance, and planning agencies worked to-
ment. Farmers in degraded areas learned to of government interests in private enter-             gether at all levels. The project was driven
develop orchards using conservation- prise after the enterprise had fully devel-                 by the Agriculture Bureau, which had the
effective measures; fishers in coastal areas oped—provided a strong foundation for               staff and technical expertise to deliver new
learned aquaculture techniques.                  mutual trust and confidence among private       technologies and follow up with farmers.
                                                 and public investors.                               “Our goal is to serve the people and
The Right Choices                                                                                alleviate poverty among our farmers,” says
The soil and water conservation interven- Enterprise Reform                                      Lin Kai Wang, Project Director and Senior
tions focused on income-earning activities All the public enterprises involved under-            Agronomist. Building on skills that were
for the farmers, because experience showed went ownership restructuring, with govern-            already available, the officials looked
that activities linked to farm income would ment ownership gradually decreasing below            closely at the markets and capacity to
succeed. Farmers were encouraged to select 49%. The Vice Chairman of the Fujian Pro-             repay the loan. They also made sure that
the option best for their situation.             vincial People’s Congress, Mr. Cao Degang,      the investments were appropriately sized.
    Agro-processing industries and agricul- says that although it is the Government’s                The success of the project was distin-
ture market development linked agricul- job to provide an enabling environment for               guished in yet another way: it was the first
ture sector production activities with the people, the people themselves had                     ADB agriculture project to receive a highly
processing and market distribution, pro- worked hard to achieve results.                         successful rating in the project completion
moting a market cycle of primary produce             Economic reforms encouraged the es-         report.

and off-farm employment opportunities. tablishment of the Rural Economic Coop-
Small hydropower development provided erative, which allowed towns and villages
the rural poor with electricity and a substi- to engage in productive economic activi-
tute for firewood, subsequently protecting ties (collective farming, agro-processing,
the forests as a measure of soil conserva- and rural industries) as a unit to collect
tion. The project area covers small water- and generate revenue.
sheds across 30 counties along the densely
populated eastern coastline.
                                                     With the project creating the funding
                                                 necessary for change and developing an en-
                                                                                                  1 Poverty and Hunger
    On average, real per capita household abling environment, the poor rural dwell-
income almost doubled from CNY1,335 ers of Fujian Province have been able to turn
                                                                                                  7 Environment
($290) (in 2003 current prices) before the their lives around, and make the most of
project to CNY2,410 ($845) at completion. their harsh environment.                                8 Global Partnership
                                                                                                                               June 2004 15
RURAL                     DEVELOPMENT

                                                                                                               Struggle in Orchards

                                                                                             Carolyn Dedolph
                                                                                                               In 1991, 40 farm households were encour-
                                                                                                               aged to develop the Heliukang Orchard by
                                                                                                               planting longan and other fruit trees on
                                                                                                               about 10 hectares (ha) of hilly, denuded
                                                                                                               land. But it was a struggle. Four years later,
                                                                                                               the farmers’ incomes were still low.
                                                                                                                   Techniques to cultivate cash crops
                                                                                                               on sloping lands were not available. In
                                                                                                               1996, the fruit farm was provided with a
                                                                                                               $410,505 loan through the Fujian Soil
                                                                                                               Conservation and Rural Development
                                                                                                               Project. The loan was used to support the
                                                                                                               Fujian Soil and Water Conservation Cen-
                                                                                                               ter in its work to disseminate appropriate
                                                                                                                   An experienced fruit farm manager
                                                                                                               was elected to run the orchard, fast-grow-
                                                                                                               ing longan varieties were planted, and sci-
                                                                                                               entific principles implemented, such as
                                                                                                               applying green manure for fertilizer. Farm-
                                                                                                               ers also received individual loans.
                                                                                                                   The farmers were trained in production
                                                                                                               and management technologies, with ex-
                                                                                                               perts giving lectures on fruit farming and
                                                                                                               soil conservation techniques.
                                                                                                                   Full production started in 2001, with
                                                                                                               2,400 trees in the Heliukang Orchard yield-

                                                                                                               ing an estimated 34 tons of longan valued
                                                                                                               at CNY202,250 ($24,450). Half the in-
                                                                                                               come goes to the farmers, and the rest is
                                                                                                               spent on operating the farm. With the trees

 A New
                                                                                                               now producing fruit, the farmers will start
                                                                                                               repaying their individual loans, typically
                                                                                                               at an annual rate of about CNY500 ($60).

                                                                                                               Budding Prosperity

                                                  Farmers no longer need                                       Although Chen Guo Hua never resorted to
                                                                                                               selling his blood, he is pleased with his larger
                                                  to sell their blood to send                                  income from the orchard and his other en-
                                                  their children to school                                     terprises: rice, watermelon, and pigs. “Be-
                                                                                                               fore this was wasteland,” he says as he cuts
By Carolyn Dedolph                              banned in 1997, many farmers were again                        grass to make organic manure. “The soil
External Relations Specialist                   left with few livelihood options.                              would wash down the hills and hurt the

                                                    Tu Xing was one of these blood-selling                     rice land.”
            ntil a few years ago, private       villages. Of the 1,300 people who live there,                      Thanks to the orchard, the village is
            blood collectors in the People’s    100 or so sold blood to supplement their                       beginning to flourish. New houses are be-
            Republic of China would go          meager farm income of about yuan (CNY)                         ing built, and farmers have been diversify-
            from one rural village to an-       500 ($60) per household in 1990.                               ing into other crops and livestock. By raising
other—and poor farmers would roll up their          Farmer Chen Zong Yu would sell his                         funds through farmers’ donations to match
sleeves. The blood collectors, however,         blood twice a month to pay for his children’s                  government funds, a paved road is being
spread more than money around the coun-         education. The going price then was                            laid to the village from the highway. It will
tryside during the 1980s and 1990s.             CNY200 ($24) for 400cc. Fortunately,                           give residents year-round, all-weather access
    Because of their lax sanitary procedures,   those days are gone forever. “Trees are a bet-                 to the main roads—and markets for their fruit
unsuspecting donors were sometimes in-          ter way to earn a living,” he says, referring                  and other produce. Most importantly, farm-
fected with hepatitis, syphilis, HIV/AIDS,      to his small plot of longan trees, which pro-                  ers have found a means to earn a living with-
and other diseases. When blood selling was      duce a small pulpy fruit similar to litchis.                   out having to sell their blood.

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

                                                                                                           Richie Abrina
External Relations Specialist                       In 1995, the Guan Wu village committee

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

                                                                                                                      His vision seems to be coming true.

                                                                                                                           1 Poverty and Hunger
                                                                                                                           6 HIV/AIDS
                                                                                                                           7 Environment
    WAYS OF OLD People in the village of An Kai
                                village of An Kai
    follow traditional aquaculture practices                                                                               8 Global Partnership
                                                                                                                                                    June 2004 17

                                   New Publications
 Disseminating information and sharing knowledge are two of the most effective tools ADB has for sustaining development. ADB
 publications inform, instruct, and inspire both members and partners in the pursuit of the Millennium Development Goals and of
 ADB’s vision of a region free from poverty.

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

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


18                  June 2004
                                                           WEB            WATCH

MDG Update: Now Online                                                                           NEWS FOR NGOS

Comprehensive web site features ADB’s MDG initiatives                                            Workshop Explores NGO-
                                                                                                 Private Sector Partner-
By Cathy P Reyes-Angus
          .                                           access to resources and markets, address   ships Against Poverty
Assistant Web Administrator                           shared problems that stretch across        Thirty representatives from NGOs, the

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

                                                                                                                             June 2004 19

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

External Relations Specialist

                  n Bali’s west coast, 3 hours
                  from the tourist crowds of
                  the island’s capital Den-
                  pasar and popular beaches
                  of Kuta, Nusa Dua, and
Sanur, is a hidden world of poverty that visi-

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

the province.                                       secondary education.                           ously managed centrally through complex

             The schools can now take charge of
                                                                                   “               and compartmentalized structures in three
                                                                                                       “The move from central control to de-
         education rather than be centrally planned                                                centralization puts great responsibility on
                                                                                                   the planning, monitoring, and evaluation
                                Cecile Gregory, ADB Principal Project Specialist
                                                                                                   on the district offices, schools, and com-

20                         June 2004
                                             Graham Dwyer (x2)
                                                                 explains Mr. Sugiana, the project manager         is soon expecting new books provided by
                                                                 at the district education office. “This is        the project.
                                                                 the first time block grants have been chan-           In its first year, the physical improve-
                                                                 neled directly to schools for the school com-     ments and school grants under the project
                                                                 mittee to manage,” he says. “We go to great       are making a mark. Education officials say
                                                                 lengths to ensure transparency so that par-       the dropout rate for basic education (age
                                                                 ents and the school committees know how           7–12) has dropped from 5% two years ago
                                                                 the money is being used.”                         to 0.02% in 2004, while the gross enroll-
                                                                     The schools post their accounts under         ment rate has risen by 117% from less than
                                                                 the project on notice boards for all to in-       90% over the same period.
                                                                 spect and conduct outreach activities to              But education remains an uphill
                                                                 ensure transparency. For example, headmis-        struggle for the poor in Jembrana. “I am
                                                                 tress Juminah reaches those that cannot or        thankful for the extra money, otherwise
                                                                 will not see the accounts by having the re-       I would not be able to send my daughter to
                                                                 ports read out at local community meetings.       school,” says fisherman Narka, whose 11-
                                                                     To ensure community participation in          year-old daughter, Noviastini, receives
                                                                 the school’s rehabilitation, Mr. Sugiana says     scholarship money at Negara 4 Junior Sec-
                                                                 that local skills are being harnessed, which      ondary School. When asked what she wants
 BREAK TIME The children of Embang Kauh 2                        also cuts the costs of the work. “Local com-      to be when she grows up, Noviastini imme-

 Primary School, Jembrana                                        munities have contributed through their           diately says: “A doctor.” Her father cuts in,
                                                                 time and labor to help improve the condi-         laughing: “I don’t have money for that.”
                                                                 tions of the school, and have also given              Attaining such a level of education may
                                                                 money directly,” he adds.                         seem an insurmountable challenge to this
                                                                                                                   father and child. But the message is getting
                                                                 Physical Repairs                                  through that education makes good econo-
                                                                 In Jembrana, the project is slowly trans-         mic sense for poor families, whose children
                                                                 forming some of the dingiest parts of the         will have higher earning potential, even if
 munities themselves—and you have to                             schools from physical wrecks to being clean       they may never fulfill all their dreams. And
 build capacity for that,” says Dedi Karyana,                    and functional.                                   for headmistress Ms. Juminah, that pro-
 the project’s secretary in Indonesia’s Min-                         Cratered, dusty concrete floors in the        vides a ray of hope.
 istry of National Education.                                    classrooms have been replaced with new                “I try to motivate parents and children
     The project is equipping the schools and                    white tiles, dirty scuffed walls have been        and stress the importance of finishing
 districts to fully cope with the challenges—                    replastered, and dangerously worn bamboo          school, as motivation to attend school has
 and opportunities—posed by decentraliza-                        thatched ceilings have been replaced.             been low in this area,” she says. “Now they
 tion, explains Cecile Gregory, Principal                            One such school is Yeh Umbul 3 Pri-           are beginning to respond. I hope that these
 Project Specialist and mission leader for the                   mary School in Mendoyo Subdistrict, where         children in the future can now have a better
 project. “The schools can now take charge                       the headmaster Suama says, “The class-            life than their parents.”
 of education rather than be centrally                           rooms here were in a critical condition. We
 planned. The project aims to help this pro-                     have repaired three out of five of them.”
 cess so that the children will stay longer                      Besides gleaming bright rooms, the project
 in school, achieve improved results, and                        is bringing electric lighting to the refur-
 have a curriculum that better serves their                      bished classrooms for the first time.
 needs,” she says.                                                   A few kilometers down the road,
     Since the academic year started in July                     Embang Kauh 2 Primary School is hoping
 2003, the first funds from the project have                     for connection to the electric grid from coun-
 been disbursed to 783 schools in the two                        terpart funds in the next stage of the project.
 island provinces. About 1,000 more will re-                     An average of 40 children aged 7–11 are
 ceive funds in the next academic year. Apart                    crammed in each of the six dark classrooms,         HEADING HOME A group of girls
 from the scholarships, these funds have been                    which get only limited natural light from

 used mostly for light to medium physical                        the neighboring paddy fields. “When the
 school repairs and quality improvement, in-                     weather is rainy and dark, we don’t ask the
 cluding the purchase of new books, reading                      students to study in these rooms, we try to
 aids, or training to upgrade the competence                     find some other activity for them to do,”
 of teachers.                                                    says headmaster Nurawa.
     As the schools prepare the plans them-                          The poor conditions are matched by the
 selves, accountability to the local commu-
 nity for every rupiah spent is crucial,
                                                                 state of the teaching aids. The students’
                                                                 books are ragged and overused. The school            2 Education
                                                                                                                                                June 2004 21

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

                                                                                            Rollie del Rosario
                                                                                                                 Each trainer conducted nine two-day train-
                                                                                                                 ing workshops over a three-month period.
                                                                                                                 Fifteen women participated in each work-
                                                                                                                 shop, resulting in the training of 1,215

Deciding For Themselves
                                                                                                                 women in each of the VDCs for a total of
                                                                                                                 4,860 across the project.

Women elected to local government are learning the                                                               Eager for Change
                                                                                                                  Although affiliated with different politi-
skills to participate fully in making decisions                                                                  cal parties, the women were united in their
                                                                                                                 views and aspirations and keen to develop
By Judy Bryant                                      Some women representatives have been                         their respective VDCs. Some said that be-
Consultant Writer and Editor                     unaware of even the simplest information                        fore being elected, they had little interest

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

22                        June 2004
Women Power
                                                                                                           ment guidelines for appraising, implement-
                                                                                                           ing, monitoring, and evaluating projects.
                                                                                                               It is hoped this will realize fully the
                                                                                                           provision of the Women in Development
The Philippines is one of two Asian countries setting                                                      and Nation-Building Act mandating all
                                                                                                           overseas development assistance to allo-
the standards in women leadership positions                                                                cate 5–30% of the resources to women and
                                                                                                           gender concerns.
By Rita Festin                                                                                                  In the private sector, 85% of Philip-
ADB Media Officer                                                                                          pine companies have women in senior man-

                                                                                                           agement, according to newspaper reports
          ed by the country’s second woman                                                                 citing Grant Thornton, a business advisory
          president, Gloria Macapagal-                                                                     firm. It polled 6,900 medium-sized busi-
          Arroyo, women in power in the                                                                    nesses from 26 major countries and territo-
          Philippines are more prominent                                                                   ries in 2003 and found the Philippines
now than at anytime in the nation’s past.                                                                  rated a close second to Russia, which has
    “Having more women in positions of                                                                     almost 90%.
power and decision making is a very impor-
tant development,” says Emmeline                                                                           Leading the Way
Verzosa, Executive Director of the National                                                                The United Nations (UN) also cited the
Commission on the Role of Filipino Women                                                                   Philippines as one of two Asian countries
(NCRFW), a policymaking body under the                                                                     leading the way in having more women
Office of the President.                                                                                   leadership positions. This is especially rel-
    “They can redefine national priorities                                                                 evant at a time when most countries in

                                                                                             Rita Festin
and policies and place women’s concerns                                                                    Asia are falling behind. Erna Witoelar, the

and experiences into the mainstream of                                                                          UN’s Special Ambassador for Millen-
politics,” she says. “This makes the goal of                                                                    nium Development Goals, said the
gender equality much more attainable.”                                                                          Philippines and India enjoy a high pro-
    Of about 40 cabinet positions in the                Having more women                                       portion of women in their legislatures
Philippine Government, 11 are currently
held by women, the highest number of any
administration. Legislation for women has
                                                  in positions of power and
                                                  decision making is a very
                                                                                         “                      and in local positions.
                                                                                                                    Elsewhere in Asia, women account
                                                                                                                for only 14.5% of lawmakers, according
also been unprecedented.                          important development                                         to Socorro Reyes, Senior Gender Adviser
                                                                   Emmeline Verzosa
                                                                                                                of the United Nations Development
                                                           Executive Director, NCRFW
Stronger Penalties                                                                                              Programme. She was quoted in news-
The country now has one of the more pro-        includes the “battered woman syndrome”                     papers as saying that despite laws and
gressive laws against human trafficking         as a justifying circumstance for self-defense,             mechanisms in place, challenges remain
with the Anti-Trafficking in Persons Act of     leaving the woman-victim free from any                     and demands are daunting. Laws need to
2003, which criminalizes all forms of traf-     civil or criminal liability if she injures or              be enforced, monitored, and documented.
ficking—with or without the consent of the      kills her abuser.                                          Women in postconflict areas also have spe-
victim—for sex tourism purposes, prosti-            The Philippines has been a model and                   cial needs that must be addressed. Aware-
tution, mail-order brides, and pornography.     pioneer in implementing a gender main-                     ness needs to be more widespread.
It also imposes stiff penalties and provides    streaming strategy in the bureaucracy. Gov-                    “Still, we remain optimistic that we are
emergency shelter, legal, medical, and psy-     ernment agencies are mandated to review                    on the right track. We believe that women
chological services to victims. It also pe-     their polices and programs, remove gender                  can meet the challenge of being a unifying
nalizes customers of trafficked women in        discriminatory practices, formulate and                    force for peace and good governance in this
prostitution.                                   implement a gender and development plan,                   critical stage when our country is driven by
    The Anti-Violence Against Women and         and allocate at least 5% of their total bud-               political divisions and conflicts,” adds
their Children Act of 2004 criminalizes         get for gender and development. Foreign-                   Ms. Verzosa.

people who commit acts of physical, sexual,     assisted projects are not spared from
psychological (including verbal), and eco-      checking their own gender biases.
nomic abuse and violence against women              The National Economic and Develop-
and their children in a marriage, when dat-     ment Authority, with the NCRFW, and the
ing, or in a common-law relationship. For       gender and development focal points
the first time, a Philippine law protects       of overseas development assistance agen-
women who are abused by their spouses,
former partners, or lesbian partners. It also
                                                cies—including ADB—will soon release
                                                new harmonized gender and develop-                          3 Gender Equality
                                                                                                                                        June 2004 23
                                                Women in Bangladesh,
                                                Nepal, and Pakistan are
                                                overcoming discrimination
                                                and numerous obstacles

                                                                                      TO LEAD
                                                to become leaders
                                                in their communities

By Jet Damazo                                       Nighat Afsar, for example, is a practic-                 were scared that we, the women, would be

Consultant Public Relations Writer              ing lawyer in Pakistan but she said she still                a hurdle for them.”
                                                did not know what to do as district coun-                        After training and workshops, though,
            axmi Maharjan tried to stifle a     cilor when she was first elected.                            they were able to resolve their problems.
            sniff as she described how it was       At the start, women members of local                         The same is true in Bangladesh.
            growing up as a girl in Lalipur     councils often just sat during meetings,                     Monjura Khanam, a member of the Union
            district in Nepal. “When I was      unable to participate, because they were                     Parishad, said she spent the first four
            a child, I thought that to be       not given instructions or ideas on what                      months of her term establishing a good
born as a girl was bad luck,” she told the      their role was supposed to be. But through                   working relationship with her male coun-
audience during a talk show, In the Spot-       training provided by ADB under a regional                    terparts because she knew that they were
light, held at ADB headquarters during          technical assistance grant for gender and                    not comfortable with her.
Women’s Week in March 2004. The talk            governance, they learned of their roles and                      Even some older women, added Deepali
show featured six women elected as local        responsibilities, their powers, and the                      Chakoraborty, also a member of the Union
government representatives in Bangladesh,       resources they can access.                                   Parishad, did not support them. “They tell
Nepal, and Pakistan.                                “Now we are very aware of what we have                   us that the Union is not a place for us,” she
    Ms. Maharjan told of how discrimina-        to do, and we are doing a lot in our commu-                  said.
tion against women began at home. Boys          nity,” said Ms. Afsar.                                            DETERMINED
were given better food and clothing, while          Another Pakistani district councilor,                         Farzana Rauf,
girls had to settle for leftovers. Boys were    Farzana Rauf, from Jalipur district, had to                       Pakistani district
sent to school, and girls were not.             deal not only with lack of awareness of what                      councilor, took
    “I thought I didn’t have any fortune,       she was supposed to do, but also with men                         an interest in
which is why I was born a girl,” she said.      who were not receptive to her presence in                         the budget and
                                                the council.                                                      negotiated with
More than Legal Limits                                                                                            the male
Gender discrimination remains a serious         Overcoming Fears                                                  councilors
problem in their countries, where women         “Not all of the men councilors were aware
                                                                                                Eric Sales (x2)

make up the majority of the poor. Their         of the system,” she said. “They wanted to
respective governments have tried to            pass the budget without our approval. And
address the problem by mandating that a         when I took an interest in the budget, they
percentage of local government seats be
reserved for women, but legal limits are not
the only barriers these women are up                      I had to prove myself in so many dimensions
against. Bigger hurdles are educational and                                    Bimala Basnet, member, Women’s Forum in Nepal
sociocultural constraints.

24                        June 2004
LEADERSHIP                                                                                                                    H E A LT H

    For Bimala Basnet, a member of the
Women’s Forum in Nepal, the men—who             HIV/AIDS Prevention
                                                in Western Yunnan
likened the entry of women into the dis-
trict/village council to a wild animal
entering the community—were not the
only problems.                                  A novel approach of combining prevention programs
    Her family and friends were not sup-
portive of her running for office. They tried   and infrastructure projects is having impact
to force her to resign after she was first      By Eric Van Zant
elected.                                        Consultant Writer

    To earn her family’s support and the
community’s respect, she worked hard in                    arge infrastructure projects, particularly major road construction, can contrib-
her household while also attending to her                  ute substantially to the spread of HIV/AIDS. They can also create an opportu-
responsibilities in the council.                           nity to spread knowledge about prevention of the disease. For that reason,
                                                           ADB has begun to include prevention programs alongside its infrastructure
Proving Themselves                              projects. In a unique move, ADB is imple-

                                                                                            Rollie del Rosario
“I had to prove myself in so many dimen-        menting an HIV/AIDS prevention plan to
sions—as a wife, as a mother, as a woman        accompany the ADB-financed Western
in the household and community, and as          Yunnan Roads Development Project in the
a leader,” she said.                            People’s Republic of China (PRC).
    Despite all the difficulties they went          “For the first time this approach was
                                                implemented on a PRC road project and,            REPERCUSSION Major
through, these women persevered and are
                                                                                                  roads can contribute
now all respected members of their com-         given the experience, I would strongly rec-
                                                                                                  to HIV/AIDS spread
munity. Ms. Chakoraborty is involved in         ommend that this be developed for all ma-
her community’s primary education, road         jor infrastructure projects,” says Jean-Marie Lacombe former officer in charge of PRC
maintenance, and dispute resolution.            road projects, and currently Head, Portfolio Management, Indonesia Resident Mission.
    Ms. Maharjan, who was thrown out of             The expressway, to be implemented under the project, will improve transport
her house by her parents when she ran           between Kunming and Ruili, a town on the Myanmar border and at the epicenter of
for office, campaigned for a citizenship        the HIV epidemic in the PRC.
certificate for women, and worked for a             Anywhere between 15,000 and 20,000 workers will be employed each day dur-
community census by registering deaths          ing construction, which is due for completion around 2007. Typically young, the
and marriages.                                  workers are usually without their families and are often vulnerable to unsafe sex.
    Ms. Basnet, whose term in office has            This leaves workers, the women drawn to the sites to work as prostitutes, and
already expired, is honored in her commu-       spouses at home vulnerable to HIV/AIDS.
nity as a nadis, or judge. She says women           The program offers an opportunity to systematically create awareness and help
had been influenced to think that they          protect people vulnerable to HIV/AIDS who would be otherwise difficult to reach.
cannot be leaders. “Women are not aware             In addition to the expressway component, the project will upgrade about
of their own potential. Now that there are      300 kilometers of local roads in some of the poorest areas of Yunnan.
good, respected leaders, other women want           Financed from the Poverty Reduction Cooperation Fund through funds provided
to be leaders like us.”                         by the United Kingdom’s Department for International Development, the program
    While a lot more remains to be done,        will raise awareness on HIV/AIDS. It will promote safe-sex practices and use of condoms,
they all feel that having women in govern-      and ensure HIV/AIDS prevention services are offered at contractors’ work sites.
ment is an important step.                          It will enhance the HIV/AIDS monitoring system, including the surveillance of the
    “I believe that if women participate        epidemic in the region.
in politics in the real sense, in decision          In the past, dealing with problems like HIV/AIDS associated with major projects
making, there will be no discriminatory         would have been dealt with through a provision in the contract with civil works
law at any level,” said Ms. Afsar. “I think     contractors, says Mr. Lacombe. Designing and implementing a specific prevention
empowering women is empowering a                program concurrently is expected to be more effective.
nation.”                                            Mr. Lacombe says the experience, which involved concerted efforts to gain agree-

   MDG                                                                                                           MDG
                                                ment from various PRC government
                                                departments, can be applied in other
                                                    Including disease prevention in the
                                                design of large projects is in keeping with
                                                the ADB’s strategy for reducing poverty

 3 Gender Equality                              and with the Millennium Development
                                                Goals.                                                           6 HIV/AIDS
                                                                                                                                June 2004 25

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

External Relations Specialist                    standards in remote rural areas of five far-
                                                 flung provinces of Indonesia—Bengkulu,
            or the ramshackle village of         Jambi, Central and South Kalimantan, and
             Tajepan, deep in Indonesia’s        North Sumatra.
             rural Central Kalimantan Prov-          Approved in 1996 with a loan of
             ince, the mighty Kapuas River       $45 million, the project has been working
             brings life and livelihood—         in the villages to create partnerships be-
as well as death and disease.                    tween families and the staff of the
    The tenant farmers and fisherfolk, liv-      puskesmas, the vast network of local health
ing in their simple wooden dwellings on          centers. Together they have been trying to
stilts along its banks, draw on the river for    improve family health and nutrition, lower
their income and sustenance. They use it         maternal and infant mortality rates, reduce
for washing clothes and dishes, bathing,         disease levels, and raise life expectancy—
and drinking. But it also serves as their toi-   targets that today are also embraced in the
let and waste dump.                              Millennium Development Goals (MDGs).
    “I am immune to any problems from                “Through assistance such as this
the river water,” declares Basrah, who lives     project, ADB has been supporting the ba-
with her family in a wooden shack atop           sic priorities that have, subsequently, been
the river. At the back of her house is a plat-   formulated into the MDGs,” says Jacques
form at the water’s edge where she collects      Jeugmans, ADB Senior Social Sectors

all her family’s drinking and washing wa-        Specialist and original mission leader for      mortality per 100,000 live births more
ter. Just above is the makeshift toilet, a       the project.                                    than halved from 470 to 213. Despite a
small opening below which flows the                  By the early 1990s, when the project        narrowing gap, these figures are still high
murky brown river waters.                        was being drawn up, Indonesia had made          compared with Indonesia’s neighbors, such
    A weather-beaten and wizened 30              rapid progress in improving its health          as the Philippines.
something—she has no idea of her exact           indicators. This trend continued through            “Improving maternal and child health
age—she has borne six children, the sec-         the project period, despite economic and        was the ultimate goal of the project,” says
ond of whom died in infancy of diarrhea.         political turmoil, and the fallout from grow-   Sulistianto, the South Kalimantan Project
But she does not make any connection             ing decentralization.                           Coordinator. “The most important issue
with her contaminated water source.                  According to ADB’s Key Indicators of        has been to change the behavior of the com-
    “It was not the fault of the river water,    Developing Asia and the Pacific 2003,           munity and create ‘family-friendly health
it was just the season for diarrhea—every-       Indonesia’s infant deaths declined from         centers’ that are more client oriented.”
body had it,” she says.                          46 per 1,000 live births in 1995 to 33 in           Over the years, a combination of tra-
    Changing such ingrained and un-              2001. Over the same period, maternal            ditional beliefs and low-quality services

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

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

                            Prioritizing Health Problems
                            Under the project, village groups were set
                            up to discuss and prioritize local health
                            problems. “Among the issues that came
                            up repeatedly were the need for clean
                            water, which is more effective in the long
                            term to fight diarrhea and skin diseases
                            than drugs, and better nutrition,” Mr.
                            Jeugmans adds.
                                The role of the health center is to pro-
                            vide medical advice and recommend solu-
                            tions to the problems identified. Each
                            family received a health card listing the
                            priorities that had been established in their
                            consultations with the local community.
                            This gives a complete record of the family’s
                            health status and basic needs.
                                Another priority identified under the
                            project was raising incomes. The project,
                            using also the Government’s counterpart
                            funds, thus set up small loans to create

                            income-generating schemes for the mem-
                            bers, including cattle raising, duck farm-
                            ing, and savings and loan activities.
                            Revolving funds were also made available
                            for members to upgrade their homes.
             Graham Dwyer (x3)

                                 4 Child Mortality
                                 5 Maternal Health
                                                         June 2004 27

                                                 Graham Dwyer
     For example, in Kurau, in the Tanah                        SAFETY FIRST Prenatal checks
Laut district of Pelaihari, South Kali-                         at Kuala Kapua’s Health
mantan, the fund was used as seed money                         Center, Central Kalimantan
to build family toilets. A small loan was
given to two families. When they built their
facility and repaid the loan, the repayment
would provide funds and a model for the
next families, and so on, in a chain. Now
almost all families in the area have their
own toilets.
     To spread the message on health and
nutrition, especially to those in more inac-
cessible areas, the health centers have
resorted to varied means, including door-
to-door outreach conducted by midwives
(see story, p 29).
     Fahrinawati, a midwife handling
Haniljayam village about 3 kilometers from
the Kurau health center, services about
30 women needing neonatal care or infor-

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

28                    June 2004
                                                                                                                                      H E A LT H

Fighting Ignorance
Traditional medicine women are key to promoting cleanliness and better health

       n the war against malnutrition and dis-
       ease among Indonesia’s rural women
       and young children, the midwives are
       the frontline troops in a two-pronged
campaign against ignorance and traditional
practices. For years, Indonesian women have
depended largely on untrained traditional
medicine women, known as dukun, for their
maternity and child-rearing needs, some-
times with disastrous consequences.
     “When people are sick, they often go to
the traditional healers, the dukun,” says Dr.
Taufiqurrahman, in charge of the Kurau
health center. “For a case such as diarrhea,
the dukun might administer herbs or just
give water accompanied by a special prayer.
Building on the belief that sickness is caused
by bad spirits, some dukun will take a gulp
full of water and spray it at the patient with
their mouth.”
     Yet for many women having babies, the
dukun provide an affordable, highly conve-
nient, and seemingly more comprehensive
service than midwives, who receive formal
training following high school and are paid
about $60–$90 per month.
     “Dukun are willing to wait for days for a
baby to be delivered, while the midwife will
                                                  Graham Dwyer (x2)

                                                                                                            CHANGING TIMES A young woman (left)
come only when it is time for the birth,”
                                                                                                            receives contraceptive pills from the health
says Ms. Fahrinawati, a midwife at Kurau.
                                                                                                            center; A midwife making her rounds (below)
“Also, women are afraid to get stitches and

injections that the midwives might admin-
ister. Plus the dukun are often willing to take
care of the baby once it is born and even                                   People are so much
wash up after birth.”                                                 better informed about
     She said the quality of dukun has been
improving, as they now receive training from                          health and nutrition. Now
local districts in three basics—cleanliness in
the area where the delivery takes place, clean
equipment, and clean hands.
                                                                      there is more knowledge,
                                                                      so it is easier to work in
     But some of the traditional nutritional                          the local community

practices can be damaging to babies and                               Fahrinawati, a midwife at Kurau
mothers. For instance, Ms. Fahrinawati says,
dukun commonly instruct the mother to give                        that before ADB’s Family Health and Nutri-
honey to the newborn baby in the belief it                        tion Project, a baby in her area died from
will stimulate them to suck. “Sometimes,                          such chronic constipation.
the babies are even prescribed crushed                                “But that would not happen now,” she
banana to try to settle the stomachs,” she
says. “The result is a bloated stomach and
                                                                  adds. “People are so much better informed
                                                                  about health and nutrition. Now there is
                                                                                                                4 Child Mortality
chronic constipation as the baby can’t di-
gest the food.” Ms. Fahrinawati remembers
                                                                  more knowledge, so it is easier to work in
                                                                  the local community.”                         5 Maternal Health
                                                                                                                                          June 2004 29
By Eric Van Zant
                                                     A new program is helping

Consultant Writer

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

Cambodia’s health situation is among the         diture of just $2 per person. They often pay
world’s worst.                                   ill-informed drug sellers, untrained healers,
    A government program that contracts          or freelancing government health workers                Expenditure on
private organizations to run and upgrade         for help—and the expense often destroys
public health services is helping change         families, homes, and lives.
                                                                                                    health care is one of
that. It offers a unique way to achieve quick         “Expenditure on health care is one of         the main reasons
results and underscores the importance of        the main reasons people are pushed into            people are pushed
innovation in working toward the Millen-
nium Development Goals.
    The widespread success of the program,
                                                 poverty—they have to sell off assets to
                                                 pay for services,” says Indu Bhushan, Prin-
                                                 cipal Project Economist, ADB Mekong
                                                                                                    into poverty—they
                                                                                                    have to sell off assets
started in 1998, has convinced officials         Department.                                        to pay for services
to expand contracting from 5 to 10 of the             The contracted clinics are often more                          Indu Bhushan
country’s 76 districts.                          effective and offer treatment closer to                            ADB Principal
    The program is part of the Health            home, which saves on transport.                                Project Economist
Sector Support Project financed through               By paying roughly $4 per person a year
a $20 million loan from ADB. The loan is         to contract health services, the government     tion between ADB, government and,
also helping construct and renovate health       program can, in a short time, lift an enor-     nongovernment organizations (NGOs) in
centers and hospitals, and support disease-      mous burden from thousands of the poorest       designing projects.
control campaigns against HIV/AIDS,              people and provide more professional care.         Villagers are responding. The same
malaria, and other diseases.                     It underscores the importance of coopera-       mother who used to hide in the bushes says,

30                    June 2004
                                                                                                                                         H E A LT H

                                                              Better Clinics                                     Financial Incentives
                                                              NGOs entice people in need of care with            Overall care improved for several reasons,
                                                              clean clinics, professional and respectful         says HealthNet International, one of the
                                                              services, and successful treatment. They           contracted NGOs. Of critical importance
                                                              use enforceable contracts, financial incen-        was an end to private practice among pub-
                                                              tives, user fees, and achievable goals to          lic workers.
                                                              motivate staff. Cambodia’s time under the              Salaries were so low in the government
                                                              Khmer Rouge and the years of civil conflict        clinics, at $10–$30 per month, that health
                                                              that followed ravaged its health system.           workers had to seek other income. Many
                                                              New services had to be created from                openly sold their services outside of the
                                                              scratch, and development has been in               health centers and could earn 10 times
                                                              progress for just over a decade.                   more than their official salaries.
                                                                   Under the 1998 plan, contractors were             Payment was raised to levels high
                                                              chosen through competitive bidding to              enough to get staff to dedicate 100% of
                                                              manage health services in five districts. In       their time to the public system. Doctors
                                                              two, known as contracting-out areas, the           and district managers settled for salaries
                                                              contractor had full responsibility for deliv-      from $120–$180 per month.
                                                              ering services—including hiring, firing, set-          “Existing district health managers have
                                                              ting wages, and allocating resources.              worked in an environment where it was
                                                                   Contracting-in, by contrast, provided         unwise to make unpopular decisions. Many
                                           Ram Cabrera (x3)

                                                              private-sector management within a pub-            managers in charge are afraid to discipline
                                                              lic sector setup. Contractors gave manage-         staff as they fear dreadful repercussions,”
                                                              ment support to civil service health staff         says HealthNet.
                                                              and could not hire or fire, but could request          An outsider is not hindered by long-
                                                              transfers and receive a budget for incentives      standing relationships with staff and man-
                  MATERNAL INSTINCT
                                                              and operating expenses.                            agers, and with reasonable incentives can
                  Increased numbers
                                                                   All five districts improved service cov-      get acceptance of new ideas.
                  of pregnant woman
                  are seeking care at                         erage in a short time, the strongest being             “Civil servants expect life-long employ-
                  Cambodia’s contracted                       the contracted-out districts.                      ment, and generally speaking, do not take
                  clinics                                          The use of health services among the          risks that could jeopardize that position.
                                                              poorest half of the population increased           The contract manager (by contrast) knows
                                                              by nearly 30 percentage points in the              he has to score within the contract period,”
                                                              contracted-out areas during the pilot pro-         says HealthNet. Failure to perform could
                                                              gram, as more and more people turned up            mean no renewal.
                                                              at the clinics.                                        By boosting salaries and putting in
                                                                   One villager, Khun Srean, came to the         financial incentives, NGOs are getting
                                                              Memut Referral Hospital for delivery of her        clinic staff to stop private practice and en-
                                                              third child. “I prefer it because it costs less,   sure quality of care. Efficient and cleaner
                                                              the hospital is clean and close to my house,       clinics are getting noticed, and patients are
                                                              and the food and services are good.”               abandoning often more expensive outside
“One day my baby had a high fever. The                             In the expansion to 10 districts, how-        treatment, and spreading the word.
health worker in my village advised me to                     ever, it was decided after consultation be-            Cambodia’s health care system remains
bring him to a hospital in Memut. There                       tween ADB, NGOs, and the Government                rudimentary. But by building new facili-
they showed me the importance of immu-                        to use a hybrid system based mostly on the         ties and contracting the management to
nization and prevention of malaria. Now                       contracting-in model.                              private groups under ADB’s project, it is
every month when the health worker or the                          Contracts with NGOs are still at a fixed      improving.

midwife calls, I always take my baby.”                        priced and based on performance, and the
     According to Save the Children Austra-                   contractor retains complete flexibility in
lia, which was contracted in the Memut                        using whatever approaches and strategies
district, “The wide level of community par-                   are deemed effective.
ticipation has led to an overall increase in                       Contracting-out created friction with
the number of patients seeking care and                       civil servants and politicians concerned
number of pregnant women receiving iron                       about losing control over health care. “The
supplements (currently 99%). All children
in our area now receive vitamin A supple-
                                                              Government was reluctant to expand the
                                                              program, and so relinquished control of the
                                                                                                                  4 Child Mortality
ments and have access to measles immu-
                                                              health services. The results convinced
                                                              them,” says Mr. Bhushan.                            5 Maternal Health
                                                                                                                                              June 2004 31
                          GETTING CONNECTED                              By Judy Bryant

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

 In 1993 the people of Phnom Penh                                        Inefficiency Flushed Out
                                                                         At the time, the number of PPWSA con-
 lacked a reliable water supply. After                                   nections totaled 26,881, only 13% of which
                                                                         were metered, resulting in inaccurate and
 a complete revamp of its main water                                     improper billing.
                                                                             In 1993 alone, 300 illegal connections
 supplier, all that has changed                                          were discovered, and most of these had been

                                                                         installed by PPWSA staff for their own
                                                                         benefit. The going rate for an illegal con-
                                                                         nection was around $1,000. The PPWSA
                                                                         earned just riel (KR)0.7 billion ($175,400),

                                                                         against an operating cost of KR1.4 billion
                                                                             What was needed, Mr. Chan says, was a
                                                                         change of culture—a complete restructur-
                                                                         ing of the organization, which would result
                                                                         in increased revenue while rehabilitating
                                                         Halsey Street

                                                                         PPWSA’s distribution network and treat-
                                                                         ment plants.
                                                                             In cleaning up PPWSA, Mr. Chan also

32       June 2004

sought to support the Government’s efforts      proved from 50% in 1993 to 99% in 2004.
to supply clean and safe water directly to
poor families.                                  Building on Success
    Now, more than 10 years on, each of         Because of its higher collection ratio,
the 82,000 PPWSA connections in Phnom           PPWSA has fully recovered its costs and is
Penh is metered, and 70% of the city is con-    now seeking to expand its network by aim-
nected to the water distribution network.       ing at 100% connection by 2005.
                                                     Many factors contributed to the im-
Challenges Ahead                                provement in the operations of PPWSA, says
“Probably the most difficult of all,” says      Xiaoyan Ye, Principal Project Specialist,
Mr. Chan, “was to increase the water tariff     ADB Mekong Department. “Political
to cover its cost. The tariff was to be in-     stability, strong government support, and

                                                                                          Halsey Street
creased in three steps over a seven-year        external assistance from different devel-
period. However, after the second increase      opment agencies are but a few.”
in 2001, PPWSA found that its revenue                But the most important factor comes

already covered the cost of supply because      from within the organiza-
of the higher collection ratio, the drop        tion itself, he says. “The
in illegal connections, and reduction of        success of this public water               The poor often don’t get the water
unaccounted-for water.
    PPWSA’s whole distribution network
was rehabilitated, with a repair team on
                                                enterprise is, to a large ex-
                                                tent, the result of a cham-
                                                pion of the cause in the
                                                                                   they need so desperately. This lack of
                                                                                   access to water has much to do with gover-
standby 24 hours a day. The public re-          person of Director Chan.”          nance and the way water is managed
sponded to encouragement by PPWSA to                 Mr. Chan’s leadership                                    Tadao Chino, ADB President
inform it of leaks, which were then quickly     was recognized at ADB’s
repaired.                                       Water Week 2004 when PPWSA won the
    By 1996, with an ADB concessional loan      ADB Water Prize 2004. The theme of Wa-
of special drawing rights (SDR)13.7 mil-        ter Week 2004 was “Water for the Poor—
lion ($20 million equivalent), and funding      Setting the Rules and Finding the Money,”
from the World Bank and the governments         and was designed to emphasize ADB’s fo-
of France and Japan, PPWSA embarked on          cus on the poor and its Water for All policy.
renewing and rehabilitating its distribution         Addressing Water Week 2004, ADB
network, a task completed by 2002. New          President Tadao Chino said, “The poor of-
treatment plants were built and old ones        ten don’t get the water they need so desper-
rehabilitated.                                  ately. This lack of access to water has much
                                                to do with governance and the way water is
                                                                                                PPWSA General Manager Ek Sonn Chan
Leadership, Innovation                          managed.”
                                                                                                (right) receives the 2004 ADB Water Prize
                                                                                          Richie Abrina

In restructuring PPWSA, Mr. Chan gave                “The water crisis in our region is essen-
                                                                                                from President Tadao Chino during the
higher management more direct responsi-         tially a crisis of governance,” Mr. Chino said. ADB Water Week in January
bility. “Members of the more dynamic,           Water Week 2004’s theme reinforced ADB’s
younger generation who possessed better         commitment to the Millennium Develop- from over. According to Mr. Chan, PPWSA
qualifications were promoted and given          ment Goals, including the target of halving still faces two major challenges: sanitation
more responsibilities,” he says. The num-       the number of people without safe drinking and 100% connection.
ber of PPWSA employees was reduced to           water and sanitation by the year 2015.
less than 400.                                       The award recognized PPWSA’s leader- To read more about ADB’s water projects, go
    Salaries were increased, in some cases      ship and innovation in project financing and to

by up to 10 times, and performance-based        good governance, consistent with and sup-
bonuses were introduced. Those who per-         portive of ADB’s Water for All policy,
formed badly were penalized.                    Mr. Chino said.
    PPWSA started to install water meters            With good leadership and improved gov-
for all connections, and set up an inspec-      ernance, Phnom Penh residents have a water
tion team to stop illegal connections. It re-   supply 24 hours a day, in contrast to 10 hours
vised and improved its consumer files and
began to educate the public, especially
                                                in 1993. The city’s poor have better access
                                                to clean water through PPWSA’s improved
                                                                                                          4 Child Mortality
high-ranking families, other government
agencies, and even PPWSA top manage-
                                                financial strength, which has enabled it to
                                                expand services to poor areas where piped
                                                                                                          5 Maternal Health
ment, of the importance of paying their
water bills. The bill collection thus im-
                                                water supplies were once just a dream.
                                                     Despite these successes, the work is far             7 Environment
                                                                                                                       June 2004 33
An increase in
mobility and
worker migration
in the Greater
Mekong Subregion
has coincided with
a rapid rise in the
rate of HIV/AIDS
infection. Steps to
counter the spread
of the disease are
showing results
By Eric Van Zant                                       Yet, ironically, it is in these countries
                                                                                                                      VICTIM An

Consultant Writer                                  that officials are coming to grips with the
                                                                                                                      AIDS patient
                                                   problem, and infection rates have stabi-
                                                                                                                      and her
              hack-like brothels line the          lized, or are slowing.
              streets of the port city of              “This is because of strong political com-
              Sihanoukville, in southern           mitment, and a wide range of effective pre-
              Cambodia. In this hub mainly         vention programs,” says Mr. Bhushan.
              for fishermen from neighbor-             In Sihanoukville, as in the rest of Cam-
ing countries, dozens of young women aged          bodia, all brothels have a policy of 100%
16 to 21 offer their bodies for as little as $2.   condom use. Brothel workers are checked
    In Sihanoukville, new port facilities are      weekly for signs of sexually transmitted
being built with help from the Government          diseases (STDs).
of Japan, and while this growth attracts               UNAIDS says the Cambodian Minis-
more migrant workers, it also draws many           try of Health recently estimated that with-
young women who come to work in the                out this intervention in the late 1990s,
brothels with dreams of making money for           HIV/AIDS infections would have been
                                                                                                   Ram Cabrera (x3)

themselves and their families. Too often,          three times higher than they are now.
these young women leave not only with
unfulfilled dreams, but also with HIV/             Mobile Infection
AIDS.                                              More than 1,000 kilometers to the north-
    Cambodia, Myanmar, and Thailand are            west of Cambodia, in Yunnan Province of
at the center of an HIV/AIDS epidemic in           the People’s Republic of China (PRC), and                          Cambodia, Myanmar, and
the Greater Mekong Subregion (GMS).                also in Myanmar, the spread of HIV/AIDS                            Thailand are at the center
    “Cambodia remains the biggest prob-            is causing concern.                                                of an HIV/AIDS epidemic
lem now, with 2.6% of the adult popula-                The city of Ruili in Yunnan Province,
tion infected,” says Indu Bhushan,                 located on the old Burma Road bordering                            in the Greater Mekong
Principal Project Economist, ADB Mekong            Myanmar’s Shan State, is a major transit                           Subregion
Department.                                        route for booming regional trade.

34                     June 2004
                                                                                                                          H E A LT H

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

border areas, and in regions experiencing             In 2001, 670,000 people were known
higher seasonal mobility.”                        to be infected with HIV/AIDS in Thai-
    To help counter this, ADB is imple-           land. In Cambodia, 170,000 were known
menting an HIV/AIDS prevention program            to be infected, and the infection rate has
alongside the road project, a unique move         slowed to 2.6% in 2002, from 4% two
that project officers say can be applied to       years before. In Viet Nam, 130,000
other infrastructure projects in other coun-
tries (see story, p. 25).
                                                  people were known to be infected with
                                                  HIV/AIDS in 2001.                                6 HIV/AIDS
                                                                                                                               June 2004 35

                                                                                                                                     Ram Cabrera
ACHIEVABLE? The Asian Development Bank takes pride in its role in helping its developing member countries—and the entire
region—achieve the Millennium Development Goals. But meeting them by 2015 will be a challenge, with many countries poten-
tially falling short of achieving some or all of the targets. ADB is committed to creating an environment for achieving the MDGs,
a shared responsibility of all development stakeholders. This issue of ADB Review highlights MDG issues and provides examples of
innovative projects that are eradicating extreme poverty and hunger, strengthening primary education, promoting gender equality,
improving health, fighting HIV/AIDS, protecting the environment, and promoting partnership.

Publisher: Robert Salamon
                                                                                              ADB ONLINE
Content Editor: Laurence Pochard                                                    
Managing Editor and Layout Artist: Carolyn Dedolph
Editor: Judy Bryant
                                                                                               To read ADB Review online, go to
Assistant Editors: Marcia R. Samson, Chona Murakami
Designer: Ram Cabrera
Graphic Assistant: Keech Hidalgo                                                               For information, send an e-mail
Photo Researcher: Tess Perez                                                                   to or go to
Advisors: Ann Quon, Ian Gill                                                         
Distribution: ADB Publications Unit
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Fulfillment: ADB Printing Unit
                                                                                               with ADB, go to
ADB Review reports on development news from Asia and the Pacific and on the activities         business/opportunities
of the Asian Development Bank, which publishes the magazine six times a year. Opinions
and materials in ADB Review do not necessarily reflect the official views of ADB. Materials    For publications, go to http://
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        or fax a message to (632) 636-2648.                                                 ISSN: 0118-8674
36                   June 2004

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