United Nations Office for Project Services

Abstract Failure of critical national infrastructures can cause disruptions with widespread economic impacts. To analyze these economic impacts, we present an integrated modeling framework that combines: (1) geospatial information on infrastructure assets/networks and the natural hazards to which they are exposed; (2) geospatial modeling of the reliance of businesses upon infrastructure services, in order to quantify disruption to businesses locations and economic activities in the event of infrastructure failures; and (3) multiregional supply-use economic modeling to analyze wider economic impacts of disruptions to businesses. The methodology is exemplified through a case study for the United Kingdom. The study uses geospatial information on the location of electricity infrastructure assets and local industrial areas, and employs a multiregional supply-use model of the UK economy that traces the impacts of floods of different return intervals across 37 subnational regions of the UK. The results show up to a 300% increase in total economic losses when power outages are included in the risk assessment, compared to analysis that just includes the economic impacts of business interruption due to flooded business premises. This increase indicates that risk studies that do not include failure of critical infrastructures may be underestimating the total losses.

The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77-0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64-0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.

The recent history of Guatemala is interpreted here using an interdisciplinary approach inspired by recent development and conflict studies. The author reflects on his experience in peace-building activities and uses a combination of primary and secondary sources to present the Guatemalan war as a complex political emergency. The first part (a methodological introduction) proposes an analytical framework, taking into account both the root causes and the different functions of violence, in order to achieve a better understanding of contemporary conflicts. In the second and central part of the article, the integrated framework is applied to Guatemala, trying to understand causes and functions of war and negotiation and underlining the existence of structural obstacles to a lasting peace. The conclusions are dedicated to policy implications: if the signing of peace accords represents only a step towards negative peace, the condition for a lasting peace is a strategy for reconciliation and development based on social participation and social justice.

Abstract Critical infrastructure networks are geographically distributed systems spanning multiple scales. These networks are increasingly interdependent for normal operations, which causes localized asset failures from natural hazards or man-made interference to propagate across multiple networks, affecting those far removed from an initiating failure event. This paper provides methodology to identify such failure propagation effects by quantifying the spatial variability in magnitude, frequency, and disruptive reach of failures across national infrastructure networks. To achieve this, we present methodology to combine functionally interdependent infrastructure networks with geographic interdependencies by simulating complete asset failures across a national scale grid of spatially localized hazards. A range of metrics are introduced to compare the systemic vulnerabilities of infrastructure systems and the resulting spatial variability in both the potential for initiating widespread failures and the risk of being impacted by distant hazards. We demonstrate the approach through an application in New Zealand of infrastructures across the energy (electricity, petroleum supply), water and waste (water supply, wastewater, solid waste), telecommunications (mobile networks), and transportation sectors (passenger rail, ferry, air, and state highways). In addition to identifying nationally significant systemic vulnerabilities, we observe that nearly half (46%) of the total disruptions across the simulation set can be attributed to network propagation initiated asset failures. This highlights the importance in considering interdependencies when assessing infrastructure risks and prioritizing investment decisions for enhancing resilience of national networks.

Abstract Small island developing states face particular challenges to ensure their infrastructure promotes social, economic, and environmental well‐being. Closing the achievement gap for the Sustainable Development Goals (SDGs) involves prioritization and coordination across multiple sectors. With an application to the country of Saint Lucia, this paper develops a stakeholder‐driven analysis framework integrating four interdependent infrastructure sectors (electricity, water, wastewater, and solid waste). Drawing on extensive consultation with decision‐makers in‐country—134 stakeholders from 18 government ministries, agencies, academia, or the private sector—the analysis identifies specific interventions that could be implemented over the next decades to meet future needs for sustainable infrastructure services. These interventions are congruent with the government's development plans. Long‐term, cross‐sectoral portfolios of investments and policies (“strategies”) are developed which demonstrably reach the targets of the SDGs and Saint Lucia's emissions reduction commitments under the Paris Agreement. The sequencing of these investments or policies is designed to optimize their efficiency and impact over time, identifying “quick wins” while ensuring that there is sufficient action to provide services in the long‐term sustainably. A comparison of costs associated with each strategy suggests that accounting for interdependencies and taking a long‐term perspective can save costs over the life of infrastructure investments. This process of infrastructure assessment is applicable beyond the small island context, allowing practitioners a means to undertake systematic assessment of a country's future infrastructure needs and to develop appropriate solutions aligned with its national objectives and international commitments.

BACKGROUND: Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality. OBJECTIVE: The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan. DESIGN: A propensity score-matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders. RESULTS: Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR)=0.67, 95% confidence interval (95% CI) 0.48-0.94], during the neonatal period by 29% (aHR=0.71, 95% CI 0.57-0.88), and for under-fives by 27% (aHR=0.73, 95% CI 0.60-0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan. CONCLUSIONS: Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths.

Abstract The 2030 Agenda is an aspiring set of goals and targets that aims to prompt humanity towards a sustainable development by 2030. In order to achieve this, actions that mitigate trade-offs and enhance synergies within the Sustainable Development Goals (SDGs) need to be identified. However, for the energy sector these actions are dispersed across the scientific literature, which is a clear barrier to encourage practitioners to have a proactive and pragmatic approach towards the SDGs. For this reason, a set of actions for energy projects was compiled. This compilation addresses the synergies and trade-offs identified in the Sustainable Development Goals Impact Assessment Framework for Energy Projects (SDG-IAE). One case of application was used to test the actions, the lighthouse Project VARGA. Subsequently, an analysis was conducted to understand how possible actions can impact different technologies, project stages, actors and SDG targets. In this way, enabling policymakers and project developers to define areas of action when evaluating policies or considering specific interventions. This article aims to be the starting point of stakeholder discussions that consistently frame energy projects within the achievement of the SDGs.

Critical infrastructure systems are typically managed as isolated systems, however, past events have demonstrated that disruptions to electricity supply can initiate major social and economic impacts on dependent infrastructure. This paper investigates the role of electricity on the functioning of the New Zealand national passenger–transportation sectors, namely: airports, ferries, rail, and petroleum distribution via state highways. Expert-elicited relationships used to define electricity-transport dependencies in practice are compared and updated using a national-scale network-of-networks simulation model – a methodology with the advantage of capturing a far greater range of possible dependency relationships compared to a single expert-elicited curve. Examining the geographic and functional dependence on the electricity transmission/distribution networks, critical substations for normal transportation sector functionality are identified. Through simulating disruptive scenarios, we derive a synthesised set of curves integrating the qualitative and quantitative approaches to characterising infrastructure dependencies. While urban areas show dense co-location of transport assets and critical substations with significant potential for disrupting transportation, the routing of petroleum from bulk storage terminals to retail stations reveal the criticality of road networks beyond simple traffic count metrics. This approach in modelling infrastructure dependencies at the national scale is not without limitations and these are reflected on accordingly.

Abstract The energy sector is the largest emitter of greenhouse gas emissions, accounting for 37% of the world’s combined emissions, and plays a key role in achieving the Sustainable Development Goals. However, there is no systematic means for planners and practitioners to integrate climate considerations throughout the lifecycle of energy infrastructure projects. Using a thematic document analysis, we provide a comprehensive list of activities related to climate mitigation and adaptation which can be systematically mainstreamed into the energy sector project lifecycle to support a range of sustainable development outcomes. Two renewable energy projects were used to integrate the results into a practical context and demonstrate the range of potential SDG target synergies. The case studies demonstrate the varied means by which climate action can be integrated through mainstreaming in project lifecycle stages, holistically achieving wider SDG impacts. This work provides a practical means to maximise progress within the framework of climate-compatible development.

BACKGROUND: Rehabilitation is an essential service for healthy ageing. Scoping reviews have described how rehabilitation is delivered to older people, however, their evidence is overwhelmingly derived from research published in high-income countries (HICs). AIM: To a) assess whether descriptions of rehabilitation service delivery models derived from the literature reflect real-world practice, and b) gather knowledge about the use of different rehabilitation service delivery models in different settings and countries, including availability and implementation status. DESIGN: Observational study. SETTING: International online survey conducted in eight languages. POPULATION: Healthcare workers involved in the provision of rehabilitation for people over 60. METHODS: A 33-question questionnaire on the characteristics of rehabilitation service delivery models, their availability and implementation in different regions of the world was distributed globally using a three-layer stakeholder mapping approach. The CHERRIES checklist guided the reporting. RESULTS: The survey was completed by 1285 highly experienced health workers from 124 countries, representing all income levels and all WHO regions. The availability and implementation status of rehabilitation delivery models (inpatient, outpatient, telerehabilitation, home, community, and eldercare) was lower in low- and middle-income countries (LMICs) than in HICs, but none of the models was fully available or implemented nationwide in any region or income level. Physiotherapists, occupational therapists, speech-language therapists, nurses, and rehabilitation physicians are the most common healthcare workers providing rehabilitation in all models and regions. Rehabilitation is often fragmented and multidisciplinary teams are often only available in the inpatient model. Assistive technology is almost always provided in HICs, but only half the time in LMICs, while environmental adaptations are not fully reimbursed by any health system and are not prescribed in some regions. CONCLUSIONS: Our findings validate and complement previous reviews by incorporating insights from healthcare workers with real-world experience across income levels and regions. Older people in LMICs have less access to quality rehabilitation services than those in HICs. Globally, rehabilitation services are partially responsive and adequate for supporting healthy ageing. CLINICAL REHABILITATION IMPACT: Rehabilitation stakeholders and policymakers can use this study to (re)design services to better support healthy ageing.

While humanitarian-private relations have always existed, the past few decades have seen a significant evolution of the engagement models and objectives that drive the interaction among the two sectors. The collaboration between the two sectors has become not only increasingly more popular, but in fact a critical element of development aid as donors set high ambitions. 2030 Agenda and the Sustainable Development Goals outline clear demands for both sectors to work together on a mission to find new and more impactful mechanisms to address the development goals. The business case demands going from millions to trillions through cross-sectoral collaboration as defined in Addis Ababa Conference on Funding for Development. This chapter provides a brief review of the evolution of cooperation between private sector and the development sector over the past 15 years, as well as the factors shaping the different needs and policies that have defined it for the future.

Following the Grand Bargain, there has been increasing focus on aid localisation and partnerships between international and local aid agencies. Yet there has been less scholarly attention on how and why international agency policies and partnerships can cause unintended harm to civil society organisations and their staff. Drawing on James Scott’s seminal work Seeing like a State, and interviews with Myanmar civil society organisation leaders in 2023, this article argues that international agencies often attempt to render civil society “legible” through processes of systematisation and codification. However, these processes can in turn sideline accrued experiential and contextual knowledge, or metis, which is necessary for local organisations’ survival, especially in times of instability. The article highlights several instances in Myanmar where the marginalisation of this more contextual knowledge results in unintended harms. The article concludes that international agencies’ acknowledgement of metis is a crucial and yet still under-recognised pillar of aid localisation.

Partie 5 "Quinoa crop in Andean countries", chapitre 5.1.bCet ouvrage a été conçu dans le cadre de l'Année Internationale du Quinoa (FAO) en 2013.

Pretomanid is a key anti-TB drug included in the WHO list of essential medications. The current EMA-approved label for pretomanid restricts its use to the regimen comprising bedaquiline, pretomanid and linezolid (BPaL) and only for extensively drug-resistant-TB or multidrug-resistant TB, "when antibiotics used for the latter form of TB do not work or cause unacceptable side effects." This restricted use implies that the older, prolonged and poorly tolerated regimens remain the recommended treatment for most cases of drug-resistant TB. The authors, representing many respiratory groups and societies, call for the label expansion of pretomanid to align with global guidelines, allowing for broader use.

Most studies comparing vaginal breech delivery (VBD) with cesarean breech delivery (CBD) have been conducted in high-income settings. It is uncertain whether these results are applicable in a low-income setting. To assess the neonatal and maternal mortality and morbidity for singleton VBD compared to CBD in low- and lower-middle-income settings,the PubMed database was searched from January 1, 2000, to January 23, 2020 (updated April 21, 2021). Randomized controlled trials (RCTs) and non-RCTs comparing singleton VBD with singleton CBD in low- and lower-middle-income settings reporting infant mortality were selected. Two authors independently assessed papers for eligibility and risk of bias. The primary outcome was relative risk of perinatal mortality. Meta-analysis was conducted on applicable outcomes. Eight studies (one RCT, seven observational) (12 510 deliveries) were included. VBD increased perinatal mortality (relative risk [RR] 2.67, 95% confidence interval [CI] 1.82-3.91; one RCT, five observational studies, 3289 women) and risk of 5-minute Apgar score below 7 (RR 3.91, 95% CI 1.90-8.04; three observational studies, 430 women) compared to CBD. There was a higher risk of hospitalization and postpartum bleeding in CBD. Most of the studies were deemed to have moderate or serious risk of bias. CBD decreases risk of perinatal mortality but increases risk of bleeding and hospitalization.

Food security has been a problem of developing countries. Recently it has also become a policy priority of some wealthy nations, notably after the 2008 economic crisis. Large scale agricultural land investment, which is referred to as land grabbing in critical literature, is being used partially as a solution to address food shortages besides, profit making. The paradox is how developing countries could be food secure while the investing countries are also driven by the same need. Africa is the main destination for those multinational companies for a variety of reasons. However, there is a debate on whether these agricultural investments are beneficial to the host countries or whether it is just land grabbing. The aim of this paper is to investigate the perceived benefit of agricultural land transactions for developing countries, precisely, in ensuring food security. National development policies are therefore key elements to be analysed in light of food security priorities. Ethiopia illustrates the impact of large scale land transactions on food security by analysing those investment deals in relation to the national development policies and by applying theories that address both availability and the accessibility of food. This analysis contributes to identifying whether large scale land investments have a positive contribution towards achieving food security and ending the dependence of developing countries? The article argues that large scale land investments hardly meet food security in Ethiopia, largely, due to the export oriented agricultural development policy of the government.

Abstract This article takes the form of a conversation between an anthropologist and seven interpreters who worked for the UN Office of the High Commissioner for Human Rights (OHCHR) during its mission in Nepal (2005–2011). As any human rights or humanitarian worker knows quite well, an interpreter is essential to any field mission; they are typically the means by which ‘internationals’ are able to speak to any local person. Interpreters make it possible for local events to be transformed into a globally legible register of human rights abuses or cases. Field interpreters are therefore crucial to realizing the global ambitions of any bureaucracy like the UN. Yet rarely do human rights officers or academics (outside of translation studies) hear from interpreters themselves about their experience in the field. This conversation is an attempt to bridge this lacuna directly, in the hope that human rights practitioners and academics might benefit from thinking more deeply about the people upon whom our knowledge often depends.

Abstract The buildings and construction sector is responsible for nearly 40% of the total greenhouse emissions (GHG). Considering 50% of the building stock that will exist in 2050 is yet to be built and most of it will be devoted to housing; the sector is a determinant and transformative force to strengthen sustainability, reducing CO2 emissions and environmental degradation worldwide. Most of the increase in construction and housing is set to occur in developing countries and mainly in cities in Asia and Africa. This global picture places new housing programs in the rapidly urbanising regions as potential agents of sustainable transformation, with positive outcomes for both communities and the environment. Investing in sustainable housing has significant and real value in reducing emissions, confronting climate change, and generating better planned, inclusive, and sustainable cities. The holistic benefit achieved with the implementation of carbon neutral and carbon negative technologies is often scattered, and an integrated view of it would be a key tool to support the development of sustainable housing programmes. Considering that technologies to decarbonize and render the construction sector more sustainable have already been developed, there is a need to contrast their applicability to different countries and contexts in order to verify their functionality and identify gaps for improvement. The recent decade has witnessed a significant improvement at the global level with regards to the application of the concept of sustainability to the built environment, this being demonstrated by the multiple sustainability ratings and frameworks being developed to certify building performance. Their adoption has been critically important in most regions in the so-called Global North, where countries have started enforcing them at a normative level. While these tools’ accuracy and comprehensiveness could be disputed, their importance in promoting a systematic standardisation of the adoption of sustainability measures in the built environment is endorsed. Nevertheless, the diffusion of such tools and frameworks across rapidly urbanising middle and low-income countries has been so far extremely limited. There are myriad reasons why this is the case: tools based for high-income country contexts, their complexity, the need for accurate data and specific capacity for their adoption and diffusion, the lack of contextual relevance with regards to the specific market, culture and behavioural dynamics, and more. The following paper aims at demonstrating the value of shifting toward sustainable building practices by a comparative analysis of existing global tools and certifications and their applicability to low and middle-income countries undergoing a rapid urbanisation process. It proposes a three-phased multi-stakeholders methodology. The outcome of these three phases is combined, providing a more appropriate definition of effective and operative guidelines and tools for sustainable housing in rapidly urbanising middle and lowincome regions.

Background and Objectives Sustainability is a working principle included in the United Nations (UN) procurement processes with the adoption of the Sustainable Development Goals (SDGs) in 2015. In the context of internationally funded projects in developing countries for procuring health-related goods during and following the COVID-19 pandemic, this article further investigates what sustainable procurement means when applied to purchasing medical devices (MDs), considering its impact on health services. It also proposes a reflection on the concepts of sustainability and quality assurance as guiding principles for technical teams during the process of MD procurement. Material and Methods This article aims to identify how sustainability can be implemented during the execution of a project based on the analysis of principles that guide procurement actions in the four UN agencies with the highest volume of MD procurement. The concept of sustainability is also explored from a macrosystemic point of view as the ratio between the impact of a procurement project on healthcare services and its investment. Its implications for population health and wealth is also discussed. Based on the experience of the authors in implementing purchasing processes of MDs, a framework for the specific technical activity is then proposed. Results In the UN system, sustainable procurement focuses on the social, economic, and environmental quality of the equipment and on the conditions of its production to guarantee that a sustainable good is procured. Not being enough, the focus should also be on the benefit of a procurement project, not as the possession of a new MD, but as the utility of the device: an instrument to provide healthcare services of the beneficiary country. Procuring sustainable goods should include planning their future use as an essential component for a sustainable positive impact on the health and wealth of the beneficiary population. Thus, the intended use of the procured devices should be defined, planned, and measured. In the proposed framework, sustainability is a ratio between an MD’s social, economic, and environmental costs and the benefits of its use. When neglecting the essential factor of sustainable use of MDs, the risk of purchasing equipment that will not be properly and efficiently used is relevant. To guarantee the sustainable use of a MD, it is essential to assess the needs, the local conditions, and the conditions for its lifelong use. Further evolution of the concept of sustainability is developed towards the possibility of modulating the project’s objective from procuring sustainable MDs to improving the sustainability of the health services by procuring MDs. Conclusion Sustainable procurement of MDs is a key factor in supporting the sustainable development of health services and health systems toward the SDGs. Post-pandemic investments to strengthen the resilience of health services in developing countries shall consider sustainable procurement, including the essential quality assurance process. This process, led by an expert clinical engineer, shall be centered on the future use of the equipment and not be limited to its quality as a material good.

Background and Objectives This article is the third in a series of three manuscripts published in this journal. It aims to describe how sustainable procurement of medical devices (MDs) can be implemented in operational projects in the context of developing countries. It also further details how the biomedical/clinical engineer lead (BCEL) in charge of technical support during the MD procurement process can apply sustainability principles and concepts of value-based procurement. Material and Methods Based on the authors’ experience of more than 20 years in procurement projects and implementation of MDs, the role of the BCEL will be developed from a theoretical point of view with the description of the second and third pillars of a sustainable purchase following the needs assessment: the assessment of existing conditions along with local capacities and the evaluation of the use conditions during the lifetime of the medical equipment. The application of these principles in operational projects will be further discussed by analyzing literature and lessons learned from projects implemented in developing countries. Results/Proposal The BCEL has a key role in the sustainable procurement of MDs to design the technical specifications of the goods, related services, and post-sales conditions to maximize the benefit of the investment. As the specialist can analyze the local existing conditions and capacities while ensuring efficient use of the MDs during their lifespan, they can contribute to a sustainable implementation of MDs in developing countries. The BCEL shall also be able to analyze the local and international markets to find all possible technological solutions that meet the needs, local conditions, and capacities and ensure quality use during the lifespan of the purchased MD. The BCEL shall have competencies in identifying all the risks related to the use of the MD from the safety risks linked to its installation, use, and maintenance to the sustainability risks linked to obtaining the conditions that guarantee the use of the device and maintaining them as long as possible. Examples of these conditions include the presence of qualified and trained users, availability of maintenance and consumable budgets, availability and maintenance of infrastructure conditions (access, electrical power, water, drainage, medical gasses, etc.), and last but not least, presence of patients requiring a diagnosis or treatment using the purchased MD who were identified during the evaluation of the first pillar: a sound needs assessment. Conclusion As an evolution of the BCEL’s traditional biomedical and clinical engineering work, he/she shall assume the responsibility to guarantee the sustainability of the MD purchase. This quality assurance and control role is achieved by a sound theoretical background knowledge based on the three sustainable procurement pillars: the needs, existing and lifetime use conditions assessments, the analysis of the local and international markets, and a broad understanding of sustainability risks.