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BACKGROUND: This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. METHODS: Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. RESULTS: 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. CONCLUSION: CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.

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Jeremy Goldhaber-Fiebert
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The film "Silent Killer: The Unfinished Campaign Against Hunger," hosted by NPR's Scott Simon, offers a compelling examination of both the problem and solutions surrounding world hunger. The program aired on PBS station KQED/San Francisco on Wednesday, November 2nd at 11:00 p.m.

SEATTLE - There are a billion hungry people in the world. Fifteen thousand children-the equivalent of five times the victims of the World Trade Center bombings-die each day of hunger. Yet it doesn't have to be this way. We can end hunger-if we make a commitment to doing so. The new one-hour documentary Silent Killer: The Unfinished Campaign Against Hunger shows how it can be done. Shot on location in the United States, South Africa, Kenya, Rome, Mexico and Brazil, Silent Killer examines both the problem of hunger and solutions. The documentary and its companion Web site (www.SilentKillerFilm.org) will provide viewers with inspiration and information to become part of the effort to end hunger.

Produced by Hana Jindrova and John de Graaf (Affluenza, Escape from Affluenza), in association with KCTS/Seattle Public Television, Silent Killer will air on several California public television stations as follows:

KTEH/ San Jose: Sunday, October 16 at 5:00 p.m. (please confirm).

KOCE/ Huntington Beach: Sunday, October 23 at 4:00 p.m.

KQED/ San Francisco: Wednesday, November 2 at 11:00 p.m., repeating on

KQED Encore (Digital Channel 189), Thursday, November 3 at 10:00 p.m.

KVCR/ San Bernardino: Thanksgiving evening, Thursday, November 24 at 8 p.m.

KVIE/ Sacramento: Airdate and time to be announced.

KCSM/ San Mateo: Airdate and time to be announced.

(For all other stations, please check local listings).

Narrated by National Public Radio's Scott Simon, the film begins in South Africa's Kalahari Desert, where razor-thin Bushmen use the Hoodia cactus to fend off hunger. But now, a drug firm has patented the Hoodia's appetite-suppressant properties and is using it to make a diet product for obese Americans and Europeans. Hoodia is a metaphor for a world where some people die from too much food, but millions more die from too little.

We discover how serious the problem is in Kenya as we meet Jane Ininda, a scientist who is trying to make agriculture more productive in her country, while her own brother, Salesio, barely survives the drought, poor soils and pests that constantly threaten his crops. Through powerful stories, we come to understand the dimensions of the hunger crisis.

At the World Food Summit in Rome, we learn how activists have been working to end hunger since President John Kennedy declared war on it in 1963. But today, America's commitment to food security is less clear. In fact, world financial commitments to hunger research are now in decline.

But Silent Killer does not leave viewers feeling helpless. A visit to Brazil finds a nation energized by a new campaign called FOME ZERO-Zero Hunger. In the huge city of Belo Horizonte, we meet a remarkable leader and see how, under the programs she supervises, the right to food is guaranteed to all. In the countryside, we are introduced to the Landless Peasants' Movement, which is giving hope to millions of hungry Brazilians.

Can we end hunger, or will it always be with us? Why should we try? What will it take? What are we doing now? Can biotechnology play a role, and if so, how? Is hunger just a problem of distribution, or do we still need to produce more and better crops? These are the questions considered in this exquisitely photographed documentary.

EXPERTS featured in Silent Killer: The Unfinished Campaign Against Hunger and available for press interviews include:

David Beckmann - President, Bread for the World. Since 1991, Reverend David Beckmann has served as president of Bread for the World, a Christian group that lobbies the U.S. government for policy changes to end hunger in the United States and around the world.

Per Pinstrup-Andersen - World Food Prize Laureate 2001. A native of Denmark, Per Pinstrup-Andersen is the H.E. Babcock Professor of Food, Nutrition and Public Policy at Cornell University. He also serves as the chairman of the Science Council of the Consultative Group on International Agricultural Research.

Chris Barrett - Development Economist, Cornell University. Dr. Barrett is a professor of applied economics and management at Cornell University. His focus is on rural communities, primarily in Africa, concentrating on the dynamics of poverty, food security and hunger.

Walter Falcon - Development Economist, Stanford University. Dr. Falcon is the Farnsworth Professor of International Agricultural Policy at Stanford University (emeritus), co-director of the Center for Environmental Science and Policy, and former director of the Stanford Institute for International Studies.

PROGRAM TIE-INS: October 16 is the 25th observance of World Food Day-a worldwide event designed to create awareness, understanding and year-round action to alleviate hunger. (See www.worldfooddayusa.org.) In addition, October 24 is the 60th anniversary of the founding of the United Nations and its first agency, the Food and Agriculture Organization (FAO).

CREDITS: Silent Killer was produced by Hana Jindrova and John de Graaf in association with KCTS/Seattle Public Television and is narrated by NPR's Scott Simon. Writer: John de Graaf. Photographers/Editors: Diana Wilmar and David Fox. Composer: Michael Bade. Executive Producer: Enrique Cerna, KCTS. Funding was provided by The Rockefeller Foundation.

DISTRIBUTOR: Silent Killer is presented nationally by KCTS/Seattle Public Television and is distributed by the National Educational Telecommunications Association (NETA).

WEB SITE: See www.SilentKillerFilm.org for more information about the film, including a full transcript, in-depth interviews with film characters and experts on hunger, a guide for teachers, a list of hunger facts and myths, a detailed "Take Action" section and additional resources. Color images from the film are posted on the site for press use, along with an online press kit.

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David Backer is a post-doctoral Fellow (Ph.D. Michigan) at CDDRL. His dissertation project was an evaluation of the impact of participation by victims in South Africa's Truth and Reconciliation Commission (TRC). He is extending this research by comparing attitudes of victims and the general public, as well as conducting a longitudinal study of victims' attitudes about reparations. In addition, he is undertaking a parallel study of victims' responses to the truth commission processes in Ghana, Nigeria and Sierra Leone.

In another project, Backer looks at modes of transitional justice around the world and their effects on political development including regime stability, human rights practices, inter-group conflict, political violence and rates of violent crime.

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For nearly two decades, most major developing countries have struggled to introduce market forces in their electric power systems. In every case, that effort has proceeded more slowly than reformers hoped and the outcomes have been hybrids that are far from the efficiency and organization of the "ideal" textbook model for a marketbased power system.

At the same time, growing concern about global climate change has put the spotlight on the need to build an international regulatory regime that includes strong incentives for key developing countries to control their emissions of greenhouse gases. In most of these countries, the power sector is a large source of emissions that, with effort, could be controlled.

The United Nations Framework Convention on Climate Change and the Kyoto Protocol included mechanisms that would reward developing nations that cut emissions, but so far the performance of these mechanisms has fallen far short of their potential.

Beginning in 2002, the Program on Energy and Sustainable Development (PESD) at the Stanford Institute for International Studies (SIIS) and the Indian Institute of Management in Ahmedabad (IIMA) have conducted a set of studies to examine the intersection of these two crucial challenges for the organization of energy infrastructures in the developing world. This research, funded by the U.S. Agency for International Development, examined power-market reforms and greenhouse-gas emissions in two key states in India. At the same time PESD was conducting a comprehensive study of electricity-market reforms in five developing countries (Brazil, China, India, Mexico, and South Africa) as well as detailed analyses of the greenhouse-gas emissions from three provinces in China in conjunction with other research partners.

PESD and IIMA presented their findings at a workshop on January 27-28, 2005, at Stanford University. The workshop brought together scholars studying the organization of the electric-power sector and other infrastructures in developing countries with energy policy makers, technologists, and those studying the effectiveness of international legal regimes, with the aim of not only focusing on new theories that are emerging to explain the organization of the power sector and the design of meaningful international institutions, but also identifying practical implications for investors, regulators, and policymakers.

The workshop offered diagnoses of what has gone wrong and what opportunities have nonetheless emerged. It focused on practical solutions and a look at the prospects for different technologies to meet the growing demand for power while minimizing the ecological footprint of power generation.

One of the key conclusions of the research and the workshop, as discussed by David Victor, director of PESD, is that electricity markets in the developing world have not progressed inexorably and consistently from a state-owned model to an open market-based model. Rather, much as the experience of the past ten years in the United States has demonstrated, reform of electric-power systems has proceeded differentially between parts of the industry and between jurisdictional units, with some segments of the power generation, transmission, and distribution systems still dominated by the state and some segments now fully responsive to signals from the market.

This hybrid condition-with portions of the electricity enterprise deregulated and other portions still fully regulated-has proven to be virtually universal and quite durable as well. For the most part, it also has proven beneficial to the overall operation of the system as well as to climate mitigation due to the fact that introduction of market forces to parts of the system tends to have a spillover effect, helping to improve efficiency in parts of the system that remain under state control.

Tom Heller, SIIS senior fellow, noted that the negotiations leading up to the

development of the Kyoto Protocol and subsequent discussions and experience have

demonstrated that the burden-sharing metaphor-expecting developing nations to

make a proportional investment and effort in reducing greenhouse-gas emissions-

will not be successful. Rather, as gross and per capita energy consumption increases in developing nations, which is occurring especially rapidly in China and India, policies and mechanisms that facilitate investment in efficient and clean energy production, transmission, and end-use infrastructures will need to be developed and rolled out.

The Kyoto Protocol provided a Clean Development Mechanism (CDM) to encourage such investment. However, the conclusion reached by practitioners developing such projects in China is that CDM is an inefficient and insufficient mechanism for fostering the magnitude of development projects that will be required to help mitigate the environmental effects of energy growth in the developing nations.

Two problems with CDM were raised at the workshop. First, the bureaucratic hurdles facing developers of CDM projects are daunting. To date no such project has received certification. Second, the Kyoto Protocol's current round of reductions targets expires in 2012, and uncertainty regarding the likely direction and form of future U.S. and European initiatives provides a disincentive to investment in CDM projects.

Alberto Chiappa, managing director of Energy Systems International, noted the good news is that in spite of these difficulties, investors are finding opportunities to develop projects to provide cleaner sources of energy and improve end-use energy efficiency. Professor P.R. Shukla of IIMA pointed out that there is a great need to align development and climate concerns if future mechanisms for climate mitigation in the developing world are to be successful.

Douglas Ogden, program officer at the Energy Foundation, noted that China has made a firm commitment to greatly increase the market share of electricity from renewable sources to 5 percent by 2010 and 20 percent by 2020 and in 2008 will adopt an automobile fuel-economy standard 20 percent more efficient than U.S. CAFE standards. Also, both China and India are engaged in developing natural gas markets in sectors traditionally dominated by coal.

Mario Pereira, director of Power Systems Research, discussed Brazil's current efforts to develop economical and efficient electricity supply through biomass-specifically ethanol derived from sugarcane bagasse. The ethanol industry was originally developed as a reaction to the oil shocks of the 1970s. Although the majority of electricity in Brazil is provided by hydroelectric projects, sugarcane ethanol has some important advantages. First, the sugarcane fields are geographically close to major centers of demand, and second, sugarcane thrives during drier periods of the year when hydroelectric production declines. The experience in Brazil thus demonstrates that renewables can provide an economically attractive source of energy for developing nations.

Looking toward the future, PESD has several projects under way pertaining to the

intersection of electricity-market reforms and global climate change. The program is expanding its research on power-market reforms through a set of case studies on independent power producer projects in ten developing nations and is also initiating a set of studies examining the introduction of natural gas to regions in India and China.

Much work remains to be done before the interface between electricity-market reform and global climate change is well understood. As energy markets in the developing world expand, addressing this question will become more and more important if we are to stabilize atmospheric levels of greenhouse gases.

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This article reports on efforts to extend a MARKAL energy model for South Africa to include rural energy choices, allowing for computation of optimal energy systems in a typical (non-electrified) rural village. A previous study (Howells et al. 2002) highlighted deficiencies in earlier efforts to build models of rural household energy behaviour, such as inadequate calibration against surveys of actual energy use in rural settings as well as limited time resolution. The present study incorporates a new village energy survey. It also deploys TIMES, an extension of the MARKAL computational framework that allows explicit modeling of time-of-day load curves, for demand side management analysis, and the representation of storage devices and end-use technologies ("appliances") that meet more than one energy service concurrently.

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David G. Victor
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Rebecca J. Elias
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Mark Howells, David G. Victor, Trevor Gaunt, Rebecca J. Elias and Thomas Alfstad contributed to the paper to be published in Energy Policy in the near future. The working paper version critiques the South African policy of Free Basic Electricity in poor areas, highlighting the stress of coincident use of electricity for cooking and the influence of energy choice by the availability of free electricity. The paper explores alternatives including LPG and credits.

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The South African government is introducing a poverty-reduction policy that will supply households with a monthly 50kWh "Free Basic Electricity (FBE)" subsidy. We show that FBE distorts the energy choices of poor households by encouraging them to cook with electricity, whereas alternatives such as liquefied petroleum gas (LPG) can deliver a similar cooking service at a much lower cost to society. An alternative energy scheme, such as providing households with clean energy credits equivalent in value to the FBE's cost, could deliver additional energy services worth at least 6% of total household welfare (and probably much more) at no additional public cost; those benefits are so large that they would cover the entire cost of LPG fuel needed to implement the scheme.

The analysis is extremely sensitive to the coincidence of electric cooking with peak power demand on the South African grid and to assumptions regarding how South Africa will meet its looming shortfall in peak power capacity. One danger of FBE is that actual peak coincidence and the costs of supplying peak power could be much less favorable than we assume, and such uncertainties expose the South African power system to potentially very high costs of service.

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Program on Energy and Sustainable Development Working Paper #42
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David G. Victor
Rebecca J. Elias
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Linda Kirschke is a predoctoral fellow at CISAC. She is a PhD candidate at Princeton University, in the Department of Politics, and her research focuses on state politics and ethnic violence. She published "Informal repression, zero sum politics and late third wave transitions" in the Journal of Modern African Studies in 2000. Drawing on the cases of Cameroon, Rwanda and Kenya, this article shows that transitions to multiparty politics place Sub-Saharan South Africa at high risk for civil violence. Kirschke was a Eurasia Title VIII Fellow at the Social Science Research Council in 2002-03, working on Russian language training. In 2003-04, she was awarded an Andrew W. Mellon Foundation Pre-Dissertation Fellowship at Columbia Universityís Council for European Studies. Kirschke has a BA in French and African studies and has worked for human rights organizations in France, London and Africa.

Reuben W. Hills Conference Room, East 207, Encina Hall

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Jeff Koseff, founding co-director of the Stanford Woods Institute for the Environment, is an expert in the interdisciplinary domain of environmental fluid mechanics. His research falls in the interdisciplinary domain of environmental fluid mechanics and focuses on the interaction between physical and biological systems in natural aquatic environments. Current research activities are in the general area of environmental fluid mechanics and focus on: turbulence and internal wave dynamics in stratified flows, transport and mixing in estuarine systems, phytoplankton dynamics in estuarine systems, coral reef, sea-grass and kelp-forest hydrodynamics, and the role of natural systems in coastal protection. Most recently he has begun to focus on the interaction between gravity currents and breaking internal waves in the near-coastal environment, and the transport of marine microplastics. Koseff has served on the Board of Governors of The Israel Institute of Technology, and has been a member of the Visiting Committees of the Civil and Environmental Engineering department at Carnegie-Mellon University, The Iowa Institute of Hydraulic Research, and Cornell University. He has also been a member of review committees for the College of Engineering at the University of Michigan, The WHOI-MIT Joint Program, and the University of Minnesota Institute on the Environment. He is a former member of the Independent Science Board of the Bay/Delta Authority. He was elected a Fellow of the American Physical Society in 2015, and received the Richard Lyman Award from Stanford University in the same year.

FSI senior fellow, by courtesy, Co-director, Stanford Woods Institute for the Environment
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