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Margaret Chan, the president of the World Health Organization, declared yesterday that the world is in need of at least 4 million health workers. "Some powerful countries have gone to Third World countries to recruit their doctors and nurses," she said, leaving developing countries scrambling to provide adequate healthcare. The staffing problem is particularly acute in sub-Saharan Africa, she noted.

But according to a new working paper by Michael Clemens at the Center for Global Development, "brain drain" isn't necessarily the culprit. Clemens argues that other factors, notably geographic constraints, performance incentives, and the stress of primary care over disease prevention, are to blame for Africa's generally low staffing levels and poor health conditions.

FP (with the CGD) also reported last year that most doctors and nurses in Mozambique, for instance, are unwilling to work in villages and slums where diseases are rife. And terrible working conditions and low pay in public hospitals lead health care workers to opt for private clinics. In Kenya, 3,000 nurses have left to work abroad—but more than 6,000 qualified nurses aren't working in the country. So while developing countries may need millions more health professionals, they also need to create better infrastructure and incentives for the health professionals who are there already.

Here's the latest example of Passport's obsession with organ donation stories. Der Spiegel reports on an unexpected consequence of China cutting back on executions as part of its image-polishing efforts for the 2008 Beijing Olympics:

According to a report last week in the daily Chosun Ilbo, the already long list of South Koreans waiting for organs is getting longer -- with the number expected to top 10,000 by the beginning of the month -- and their chances of getting a transplant are getting slimmer with China having decided to ban organ exports. In addition, executions in China have dropped sharply since the Chinese New Year in February, meaning that one of the primary sources for exported organs has dried up, organ brokers told the Korea Times.

Because South Koreans traditionally shy away from donating their organs, the situation for the seriously ill in the country looks grim. Furthermore, prices for organs have skyrocketed, with kidneys now going for $37,000 whereas prior to China stiffening organ export rules a kidney could have been had for $27,000. China has likewise elected to no longer give foreigners priority when it comes to organ transplant waiting lists.

It's an odd and meaningless coincidence that around 10,000 South Koreans need organs, while China executes more than 10,000 people each year (according to Human Rights Watch). But—and perhaps I'm just suffering from brain damage and have therefore lost my moral moorings—one thought that popped into my head while reading the above story was: Is there an actual policy dilemma here? 

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Of course, explicitly taking one life to save another is reprehensible. Once you start down that road, all kinds of perverse outcomes can result. China executes more than its fair share of innocent victims, and doles out the death penalty in many cases that don't fit the crime. Still, it's an interesting thought experiment to imagine what the optimal Chinese execution rate would be in an abstract utilitarian universe. I suspect that someone else out there has taken the idea quite seriously, however—and that's a disturbing thought.

If you live in the midwestern U.S. state of Kansas, some "breast milk" rice could be blowing your way soon.

Ventria Bioscience has received preliminary government approval to grow rice plants containing genes involved in producing human breast milk. The plants could one day be used for the noble purpose of developing drugs that would treat diarrhea and dehydration in babies. If final approval is given in April, Ventria would begin planting the rice over 3,000 acres of Kansas farmland sometime in April or May.

The plan, of course, has its critics. Some worry that high winds or human error could cause the experimental plants to enter the human food supply. In 2002, genetically modified corn from the United States somehow got into Mexican fields and began spreading naturally by cross-pollination.

Let's hope that no Kansans start erupting in spontaneous lactation.

In the West, we worry about obesity, but "hidden hunger"—a lack of access to essential vitamins and minerals in the diet—may be a more serious problem. Around the world, more than 2 billion people suffer from micronutrient deficiencies, and half of all deaths among children under the age of five can be attributed to malnutrition.

How can the world solve this problem? The good news is that tackling malnutrition is second only to control of HIV/AIDS in terms of development effectiveness and value for money, according to the venerable economists of the Copenhagen Consensus. The challenge has been to get governments, donors, and, crucially, the private sector to pay attention.

Companies have a huge role to play in combating malnutrition, and they have real incentives to add vitamins and minerals to their food products. Recent research led by the Corporate Social Responsibility Initiative at Harvard has better outlined the business case for corporate action:

Fortified foods provide new opportunities to add value, and economies of scale will lower prices and reach new customers. In addition, raising product quality will stimulate competition and trade. 

The countries whose children are worst affected by malnutrition include many of the biggest emerging markets for private sector investment, such as India, China, Nigeria, Indonesia, and Vietnam, so the incentive is there. Multinational firms are starting to take notice, and the topic featured on the program at Davos this January. 

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A government survey has found that over 40 percent of women in India have never heard of AIDS. In a country where 5.7 million people live with HIV/AIDS, according to the United Nations, that's bad news. Activists blame poor awareness for the spread of the disease, particularly among women.

Perhaps there is some good news about AIDS in India, though. A recent study in the Guntar district of Andhra Pradesh, the state with the highest HIV rate in India, found that the government's estimation of the number of HIV-infected people was highly inflated. The researchers found that the real figure was less than half of what the government believed. However, the U.N. has warned against drawing "hasty conclusions" and generalizing the findings to the entire country. Either way, it doesn't help women to be in the dark about HIV/AIDS, especially with the growing "feminization" of the disease in India. Women now account for almost 40 percent of those infected with the disease in India. Sadly, this new survey on women's awareness of AIDS also highlights that not only is wealth in the country failing to trickle down, so is information that can save lives.

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Indonesia, the country with the highest number of human bird flu victims, has decided to share samples of its H5N1 virus with drug manufacturer Baxter International instead of the World Health Organization. In return, Indonesia will gain full access to any vaccine Baxter develops, according to the agreement. The move comes as the WHO is striving to extend international sharing arrangements for seasonal flu strains and potential pandemics, so the global health body is very concerned about the deal.

Baxter has made it clear, though, that Indonesia's decision not to share with the WHO has nothing to do with its agreement. So why is Indonesia refusing to collaborate now? Health Minister Siti Fadillah Supari explains:

[Specimens sent to the WHO] have been forwarded to their collaborating centre. There they have been used for various reasons such as vaccine development or research.

Later they sold the discovery to us… This is not fair. We are the ones who got sick, they took the sample through WHO and with WHO consent and they tried to produce it for their own use.”

The WHO fears that everyone will lose out if other countries follow suit. Drugs would likely become more expensive for those countries not party to a private deal with a drug company. Ironically, through its arrangement with Baxter, Indonesia could actually be making its problems worse in the long run.

Now that we've got your attention, we'd like to direct you to this week's Seven Questions with Jill Youse, the founder and executive director of the International Breast Milk Project.

Last year, the 29-year-old Youse had a freezer full of excess breast milk from nursing her newborn daughter. She thought it would be a waste to pour it down the drain. And so she did a little research, and found that if every baby in the world were exclusively breastfed for the first two months of life, 1.3 million lives would be saved every year. She looked into donating her milk to an orphan clinic in Durban, South Africa, rounded up some donations from companies that helped her with the shipping and the processing, and now, nine months later, there are hundreds of women around the U.S. who want to donate, too. And it won't cost them a thing. Take a look at the interview here, and learn how you can help.    

A side note: Youse has only ever left the U.S. once in her entire life, and it was for a two-week trip more than a decade ago. So, she's never been to Africa, and has never visited the orphans who've benefited from her hard work.  As she said during the interview, "I've heard that there are 2-for-1 specials on airfares to Africa through February, but I'm not sure if I can make it." So if there's anyone out there who wants to help (Angelina, I'm talking to you!), give us a holler at passportblog@ceip.org.

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Getting nipped and tucked at one of Cairo's rapidly-proliferating "bargain" plastic surgery clinics is probably a bad idea, despite rock-bottom prices ("arm or thigh liposuction for LE 1,500 ($260) only!") and aggressive marketing practices:

Upon visiting one such center in central Cairo, an AFP reporter was immediately offered a 'Nefertiti nose' for a few hundred dollars by a doctor without a diploma."

There's little recourse in the event that the procedure goes seriously awry, says Dr. Mohammed Kadry of the Egyptian Society of Reconstructive and Plastic Surgeons:

They maintain a high turnover ... That way if a problem arises, these centers can always say 'Sorry this doctor doesn't work for us anymore'," he explains.

And they do go awry:

[R]ecurring accounts of freakish mishaps by bogus surgeons and even the much publicized deaths of two women in September 2003 from complications after liposuction have failed to dissuade patients from flocking to bargain centers.

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Thousands of Hindu holy men are threatening to boycott the Hindu festival of Purna Kumbh Mela on the grounds that the Ganges, India's holiest river, is too polluted to wash away the sins of the millions of pilgrims who visit during the celebration. The seven-week festival is expected to draw 70 million people to the banks of the Ganges. Indian government officials, under pressure from the holy men, are offering to pump in fresh water.

The Asian Development Bank (ADB) warns that Asia's greenhouse gas emissions will triple over the next 25 years.

According to a report entitled Energy Efficiency and Climate Change: Considerations for On-Road Transport in Asia, carbon dioxide emissions from vehicles are set to rise 3.4 times for China and 5.8 times for India, primarily due to development and growing urban populations. According to the World Health Organization, this could led to "as many as 537,000 premature deaths each year, as well as a rise in cardiopulmonary and respiratory illnesses."

With the amount of growth and development taking place in Asia, the region will struggle to cope with air quality and climate change. Conferences such as the Better Air Quality Conference highlight the efforts that are taking place in toughening up on emissions, but Asian countries will need to translate talk into action. As Lew Fulton, a transport expert with the UN Environment Programme, explained to conferees, the challenge is immense:

We're not only seeing increases in pollutant emissions. We're seeing huge increases in fuel consumption which is coupled tightly with [carbon dioxide] emissions... It's costing cities and countries ever increasing amounts of foreign exchange with the high oil proces that we've got.

What do camels, llamas and sharks have in common, aside from their notoriously bad tempers?

Well, according to a recent study published by the American Chemical Society, the blood of all three animals contains a rare antibody that is ideal for detecting biological agents. This antibody is more resilient than those that are currently used for biosensors, making it a potential low-maintenance substitute that is easier to produce.

I'm just glad the animal kingdom is finally stepping up to its responsibilities in the fight against WMD proliferation.

The EU recently released fertility statistics for the EU-25, and the new numbers point to an increasing number of Europeans choosing to have children out of wedlock (32.2%) vs. inside marriage (67.8%). The leaders of this trend, as the map from EUROSTAT at right shows, are the Scandinavian countries. In Denmark, for example, 60% of firstborns have unmarried parents. That figure hits 80% in certain districts of Norway.

While the United States still has more children being born out of wedlock (37%) than Europe as a whole, the profile of unmarried couples differs sharply. In the U.S., births out of wedlock are still associated with teenage pregnancies and poverty. In European countries like France, they have no such stigma. Ségolène Royal, who just won the Socialist Party nomination for France's presidential election next year, has been living with Francois Hollande, the party's leader, for 25 years. They have four children and remain unmarried. And they're hardly the only prominent French couple to prefer l'amour without marriage.

A closer look at the map reveals another interesting correlation. The countries in which birth rates are increasing are the same countries that have a larger percentage of children out of wedlock. It looks as though the current generation of childbearers is thoroughly rewriting their parents' family model.  

One of the more intriguing aspects of the Litvinenko assassination and investigation is why the killers would have used such a bizarre and dramatic method. If this story is correct—and I don't know that it is—investigators have already traced the substance back to a particular Russian reactor. Surely whoever initiated the plot knew that the material would be traced. Two explanations seem most likely. First, someone is trying to frame Vladimir Putin by ensuring both that the killing was as dramatic as possible and that it gets quickly linked to the Russian state apparatus. The second and far more chilling possibility is that Putin or his associates ordered the hit and wanted everyone to know it was them. Some experts have pooh-poohed the idea of a Kremlin connection.

There was no benefit to Putin or Russian intelligence services to have a highly publicised operation like this." 

But was there really no motive? Aside from the benefit of removing a nettlesome critic, can't a demonstration of ruthlessness itself be useful to a politician? The Kremlin might have calculated that the fear and awe generated by the killing would outweigh the opprobrium. It's better to be feared than loved, after all.   

If you've been fortunate enough to do a bit of traveling around the world, chances are you've found yourself in a situation that didn't afford you, shall we say, "access to sanitation." And perhaps you returned home and were more than a little grateful every time the water tap turned on and the toilet flushed, but the access soon returned to being routine. If such luxuries are surely taken for granted by most in the developed world, a new report from the U.N. drives home the effects of 2.6 billion people around the world lacking access to a decent bathroom. More than two million children die each year of illnesses caused by contaminated water.

In Kibera, the sprawling slum in Nairobi, Kenya, people defecate in plastic bags that they dump in ditches or toss into the street — a practice known as "the flying toilet." In Dharavi, the vast slum in Mumbai, India, there is only one toilet per 1,440 people — and during the monsoon rains, flooded lanes run with human excrement.

The problem, according to the author of the report, is that bureaucrats and politicians often don't want to talk about toilets. Such topics are often just taboo. He told the NYT that "issues dealing with human excrement tend not to figure prominently...[on] the agendas of governments." So, despite U.N. estimates that it would cost $10 billion a year (think about that in terms of most countries' military expenditures) to cut in half the percentage of people needing clean water and a latrine, little at the government level is ever accomplished. 

Still, at least one water NGO had criticisms today not for developing country governments, but for the United Nations. A spokesperson for WaterAid told VOA News that, with nearly two dozen U.N. agencies dealing with water issues, not one U.N. department actually monitors and evaluates whether recommendations are being put in place. "[T]here is no United Nations body there standing up and naming and shaming governments, donors and recipients who are not performing on water and sanitation," he said. With so many lives at stake, it's time to get past the taboo.