This week, the 2010 Global Maternal Health Conference in Delhi brings together policymakers from all over the world to focus on decreasing maternal mortality rates in the developing world by using public advocacy to inspire public will.
As the first session got under way, panelist Gita Sen, a professor of public policy at the India Institute of Management, drew attention to some jarring news. Sen held up an article from the Hindustan Times, a report on a pregnant woman who died after giving birth in a busy market, mere miles away from where the conference was being held.
The story is unfortunately familiar to too many women around the world and reiterates the gravity of the issue at hand. However, as I sat at my desk at the UN and watched a live streaming of the conference I was struck by the fact that more and more advocacy groups are coming together to focus on how to use social media to spread information about a cause as opposed to the cause itself.
The question is one that needs careful consideration, especially as the mediums to generate grassroots support expand every day. In the digital age, everything from Facebook to LinkedIn presents an opportunity to promote a cause and it seems that nearly every .org must also have a Twitter account. But for the women in developing countries, this issue is more than the latest fad in global health—it is their lives.
The Maternal Health conference is the latest event to highlight maternal mortality, the fifth Millennium Development Goal. This Goal has received a big boost of publicity in the build up to the September MDG Summit, with everyone from the Secretary-General to filmmakers; even supermodels are getting involved. However, translating awareness into political will remains an obstacle for NGOs and others hoping to push governments to prioritize the problem.
Big names, trendy topics, and webcasts create more public awareness regarding maternal mortality. But will this cause donors and governments to move from pledges to commitments? Does social media have the potential to not just identify the nameless women of the world but also improve their lives?
This post by Gabriel Nada was originally published by Global Voices Online, a website that translates and reports on blogs from around the world.
Recently across China, more than 20 infant girls have been found to have begun developing breasts in what has been called “mini-puberty”. Reports also indicate that at least 3 infant boys also have been found with elevated estrogen levels. The levels of female hormones in the small children, ranging between 4-15 months old, is greater than that of an average adult female. In fact, levels have been detected which are more than double the normal average for an adult female.
Although the Chinese Ministry of Health (卫生部）has said that tests have cleared the milk powder of containing levels of hormones beyond the allowable range, Chinese media and bloggers are still talking about what this newly uncovered event means.
Certainty vs. Uncertainty
What is certain is that these infants have hormone levels higher than a normal average woman and that the girls have begun developing breasts. It is also certain that all of the affected children were consuming the same brand of Synutra milk powder (圣元奶粉). What remains officially uncertain is what the cause is.
With 2008′s melamine (三聚氰胺) additive milk scandal involving the Three Deers Brand (三鹿) still recently fresh on many people’s minds, and both the government and the companies eager to avoid further damage to China’s brand and country image, the company and government are denying that the cause is linked to the product. However, no other cause has yet been determined. Until a conclusive test proves a link between the powder and the elevated hormone levels, it would be too early to convict Synutra on appearances, but there are questions which are being asked that remain unanswered. (more…)
The maps are useful for policymakers, practitioners and researchers for planning, implementing and advocacy. The project aims to create a single database with all available information on the dominant worm infections, STH and schistosomiasis. Other researchers should support this effort.
President Obama recalled being publicly tested for HIV near the Kenyan village where his father was born during an address Tuesday to young leaders from 40 Sub-Saharan African nations visiting Washington D.C.
Following his formal address, several attendees asked the President questions. Among them was a young Malawian who had attended the International AIDS Society conference in Vienna.
“Mr. President, HIV/AIDS is greatly affecting development in Africa. And if this continues, I’m afraid I think Africa has no future. And I think the young people like us must bring change. And we really need a strong HIV prevention program. But, again, access to treatment must be there.”
Obama’s response commended President’s Bush’s initial commitment to PEPFAR and his own pledge to continue supporting HIV/AIDS care but within the context of strengthening health systems. Obama said:
We’re never going to have enough money to simply treat people who are constantly getting infected. We’ve got to have a mechanism to stop the transmission rate. And so one of the things we’re trying to do is to build greater public health infrastructure, find what prevention programs are working, how can we institutionalize them, make them culturally specific — because not every program is going to be appropriate for every country.
Below is the selected transcript of the question on HIV prevention and President Obama’s answer along with the video of the entire address. You can read the entire transcript here.
Too much of the commentary about AIDS 2010 streaming through my RSS feeds over the past two weeks came from U.S.-based sources, despite the great international representation attending the Vienna conference.
The Nigeria Health Watch blog, however, has several posts providing a West African’s perspective. In his final reflection on the conference, Chikwe Ihekweazu laments “the sad data coming out of Nigeria, and the absence of leadership from our Ministry of Health at this conference, as well as the little scientific research from Nigeria.”
The author points out that Nigeria’s capitol city was frequently mentioned at the conference because of the 2001 “Abuja Declaration,” when African leaders agreed to dedicate 15% of their national budgets to health. IRIN/PlusNews created this map to show nations’ progress.
If you go to the site and scroll over the countries, the map tells you national health spending, as well as the percent of child deaths attributable to HIV. In the majority of countries, it’s 5 percent or less. The highest portions are in southern Africa, peaking in South Africa, where significantly fewer children die before age five but HIV takes the lives of the nearly half who do.
Maps like this help me put the current debate on global health spending into context. It demonstrates that each country has different health system priorities, and lumping them all into a spiteful debate pitting one disease priority against another will not lead to helpful progress.
Public Health 2.0 advocate Andre Blackman blogs regularly at Pulse + Signal.
Although I didn’t get a chance to attend in person, I was able to keep tabs on what was going on at the AIDS 2010 conference this year through one of my favorite social tools: Twitter.
By dropping in the hashtag for the conference (#AIDS2010) you can see the real time updates of what folks are saying about the event. Here are 11 great resources that stood out to me – hopefully they are useful to you:
5. UNAIDS Today website: new multimedia resource created in time for the Vienna event. Features blog posts covering relevant AIDS2010 material including videos, photos and commentary on the conference. (more…)
We learn from our mistakes. Ideally, we also would learn from others’ mistakes so we don’t repeat them. That’s difficult when no one talks about them.
At a recent meeting of high-level global health stakeholders, I heard several attendees call for a safe space to share failures. And earlier this month, Dr. Rajiv Shah committed his agency, USAID, to creating “an environment safe to report on things that don’t work.”
How does one go about creating such a environment? Who starts? What is the best way to document and share these failures? A failure blog, detailed case studies, conference sessions or all of the above? Whether this safe environment for failure materializes or fizzles rests on strong, visionary leadership.
As part of the "Rapid Assessment of Malaria in Pregnancy" project, Gail Stennies, M.D., CDC/DPD/Malaria, EPI Branch, is shown here supervising Burkina physicians as they learn to use a rapid diagnostic test for malaria. Photo Credit: U.S. CDC
By Bill Brieger
The need for rapid diagnostic tests (RDTs) for malaria case management has never been clearer since of the publication by Gething et al. that only 43% of febrile episodes in malaria endemic countries are actually malaria. They did find that fever is a better indicator of malaria in areas of higher transmission, but in no situation can a clinician be confident that fever equates automatically with malaria.
Unfortunately, that confidence is more the rule than the exception. In Burkina Faso, for example, health workers are taught to use the algorithm to the right in diagnosing malaria in patients greater that 5 years of age (at present there are not enough RDTs to use on children below 5 years).
In reality, health workers still provide artemisinin-based combination therapy (ACT) antimalarial drugs to most people who present with the classical symptoms of fever and headache. Even when RDTs are used, negative tests are frequently treated with ACTs.
Health workers explain that during their training they were told that a negative test does not mean the person does not have malaria. While this is true to a very small extent, RDTs in current use are more that 90% accurate if stored and used properly. Gething’s results should cause health workers to think harder. (more…)
The International AIDS Society Conference aims to create a media frenzy every two years by gathering 20,000 people working on HIV/AIDS issues and releasing results from scientific studies to prevent and treat the disease.
The conference wrapped up last week, and indeed, attracted many headlines.
One headline, in particular, attracted significant controversy because some allege it was published too early.
Scientists often delay publishing study results for months in an effort to capture some of conference’s media spotlight. While results are not released to the public, however, select people in the field already know about the results.
The Financial Times ran a story about the study published in Scienceon the preventive benefits of a vaginal gel infused with the antiretroviral drug, tenofovir. The reporter, Andrew Jack, was accused of breaking the conference embargo by running the story before the conference session formally released the findings.
Defending his judgment, Jack says he never saw the study findings in advance and published a story based solely on interviews with scientists familiar with the results.
Embargoes by conferences and academic journals have long irritated journalists mostly because they don’t create a fair playing field. Ivan Oransky dedicates a blog to the topic, Embargo Watch. There, you can find a detailed overview of this purported embargo break. One aspect of the embargo Oransky points out was that the Caprisa results were live on the conference web site in advance, thus allowing financial analysts and investors to discuss and trade on the news, while journalists couldn’t yet publish the results.
The reality is that many scientists working in the HIV/AIDS field were already familiar with the tenofovir gel study findings. Like many studies, the release of the results was long delayed for the conference.
Yesterday, some colleagues and I were discussing whether delaying important study findings for a larger media megaphone helps or hurts scientific advancement. What do you think?
I just returned from my seventh trip to Ethiopia and I’ve been back in the United States for less than 48 hours. After only 120 days spent in Africa, I’m hardly an expert on anything that is happening or has happened there. And yet, I have a few impressions that seem worth sharing, particularly around how business can assist in the elimination of extreme poverty.
While there, I saw some incredibly encouraging relationships and budding opportunities for sustainable business models. For example, products from Stanford’s Extreme Affordability course are selling and creating business opportunities for local entrepreneurs. These include the d.light, the Mighty Mitad and, most recently, a budding joint relationship for the production of manual well drilling equipment for rural well drilling businesses targeted for vocational school graduates.
Unfortunately, these are small and isolated examples of business opportunities (outside of the rural staple of subsistence farming and the urban staple of selling retail necessities). More often, instead, I bump into those places where well-intentioned philanthropy produces a long-term, unintended negative consequence. The following are a few examples. (more…)
Leveraging information technology to improve health and fight poverty is front and center of the global development agenda. Yet, rich countries create and export the bulk of the software development sent to solve problems in developing nations.
A growing grassroots movement among some progressive software developers recognizes the limitations and selfishness of this approach. E-health companies like DataDyne and Dimagi want to build capacity for local technology development by promoting a “coded in country” initiative where companies devote at least 50 percent of their programming budgets toward efforts that train and mentor talented junior developers in developing countries.
According to Dimagi’s web site, the fact that developers in rich countries write most of the code for poor countries “is unsatisfying on many levels, including that the projects remain foreign solutions, incur high maintenance expenses, and that these solutions are often overly dependent on single individuals.”
Also, you can participate next week in a “coding-in-country” discussion at GHDonline’s health IT expert-led discussion on local software development for global ehealth. From July 19 to 30, Ahmed Mohammed Maawy of DataDyne, and Melissa Louden of the University of Capetown, will moderate the discussion. Scheduled panelists include Jacob Mtalitinya, of ITIDO in Tanzania, William Aviles Monterrey of the Sustainable Sciences Institute in Nicaragua, Lim Chanmann of InSTEDD iLab in Cambodia, and Ali Habib of Interactive Research and Development in Pakistan.
Spanish and French translations will be available on the discussion page. For more information on the panel email healthitpanel@ghdonline.org.
Dr. Donald Berwick was appointed today to lead the U.S. Centers for Medicare and Medicaid Services. CMS is one of the federal government’s largest bureaucracies, accounting for one in five dollars in the federal budget and nearly one in two dollars spent on health care.
This is a big, important job.
Berwick has been tackling big, complicated problems for a long time as the CEO of the Institute for Health Care Improvement. That is where I had a small interaction with him that strongly shaped my thinking about effective leadership.
While completing my master’s degree in public health at Johns Hopkins, I did a practicum with IHI’s research team for the Triple Aim platform. The Triple Aim is based on the premise that “improving the U.S. health care system requires simultaneouspursuit of three aims: improving the experience of care, improvingthe health of populations, and reducing per capita costs ofhealth care.” Here is Berwick’s 2008 Health Affairs article describing the Triple Aim.
My project was on how comparative effectiveness research could be used in the United States to improve health care quality and lower costs. I looked at how England’s National Institute for Health and Clinical Excellence (NICE) and Germany’s Institute for Quality and Efficiency in Health Care (IQWiG) compare the cost-effectiveness of medical interventions to decide what care the nations should pay for. I extracted lessons relevant to the U.S. and specifically CMS and reported my findings to the IHI executive team, including Berwick.
My presentation was informal and would have minimal, if any, real impact IHI’s work. I was a nobody, a lowly intern.
A few hours after I left, I received a direct email from Berwick thanking me for my research and work. I was stunned. I never imagined that someone so important would take even a minute to write a personalized thank-you note to someone as inconsequential as me.
I learned a lot from my research on cost-effectiveness analysis and health policy in England, Germany and the U.S. But the most important and applicable thing I learned from that experience was that even really important people can admit they learned something from an intern and say thank you.
Even for those of us not leading national health care quality improvement campaigns, it’s easy to brush off small gestures of appreciation as inconsequential. But with that one minute it took him to write me a message, Berwick made me an even stronger believer.
(To learn more about Berkwick’s background, see Kaiser Health News’ resource called “Who is Donald Berwick?” This post also skipped over the debate raging between Democrats and Republicans over Berwick’s nomination. See more about that here and here.)
In a speech Tuesday, United States Agency for International Development Director Rajiv Shah revealed his inner geek when he said, “I, in particular, think a good health system can be quite sexy.”
Shah was describing why President Obama’s $63-billion Global Health Initiative emphasizes the need to strengthen health systems in developing countries to save more lives.
“The ultimate target of the GHI is not to build health systems for the sake of building health systems,” Shah said. “It’s to achieve more health outcomes and sustain those gains over the long term.”
Shah spoke at the Center for Strategic and International Studies in Washington D.C. More than 1,400 people watched the live webcast available here.
Appointing Shah, a doctor and former Gates Foundation executive, to lead USAID demonstrates the Obama Administration’s interest in global health as strategic security and humanitarian issue. The Global Health Initiative has drawn heat, however, from HIV activist groups that say it calls for inadequate funding increases for global HIV treatment.
One of the best pieces I’ve read on this debate was this week’s Foreign Policy article aptly called “The Long Emergency.” Journalist Emily Dickinson asks many government officials and advocates, “Is AIDS still an emergency?”
Her takeaway: “Building health systems is essentially what the development community has been trying to do for decades. Billions of dollars in aid and decades later, bilateral, multilateral, and private aid to the developing world has — with notable but few exceptions — failed to create health systems in poor countries that can respond to crises of the magnitude of HIV/AIDS.”
When an audience member asked Shah on Tuesday if AIDS still required an emergency response, he ducked the question, saying his colleague Eric Goosby who leads PEPFAR — the President’s Emergency Plan for AIDS Relief — could provide a better answer. Then he added, “I like thinking of everything in global health as an emergency.” Preventing the eight million child deaths that occur each year, he said, requires urgent action that is results oriented and based on clear metrics for success.
Shah began his speech emphasizing the need to focus on improving maternal and child health. He described the experience of a woman pregnant with her third child in subSaharan Africa and contrasted it to that of his own wife, also pregnant with their third child.
Then, most of Shah’s speech covered the basic talking points of the GHI: focus on patients and not the disease; integrating health systems; transferring country ownership; and prioritizing innovation. He spoke of the need to build on the strengths from PEPFAR and the President’s Malaria initiative. Shah also promised “an environment safe to report on things that don’t work.”
I doubt we will see USAID press releases or blog posts about failed development experiences, but talking candidly about what hasn’t worked in the past, will help figure out what might work in the future.
Please suggest how we can improve the blog to be more useful and send us links we overlooked. Do you want to contribute? Contact us at admin@pubhealth.org
Looking into the methods of the studies that show home births are riskier than hospital births. Might a deep examination of the methods reveal something of the motives?
