Thoughts on Next Month’s Global Partnership Ministerial in Mexico City

The Mexico City meeting is part of a series that started in Rome in 2003. Subsequent meetings in Paris (2005), Accra (2008) and Busan (2011) created an ever-stronger set of principles related to the effectiveness of development interventions. As time has gone on, the donor profile at these meetings has receded as partner nations in the developing world began participating in large numbers and with growing intensity. The global development challenge will require better coordination among all constituencies and this forum more than any other has the potential to play that role.

By enacting discriminatory laws in Uganda and Nigeria, health is put at risk

A statement from Karl Hofmann, PSI President and CEO

PSI believes that all people share equal human rights and that no person should be subjected to discrimination or violence on the basis of sexual orientation or gender identity.

Men who have sex with men are among the highest risk groups for HIV transmission, and discriminatory laws such as those recently adopted in Nigeria and Uganda will increase stigma, incite violence and have a negative health impact.

Such laws also undermine progress toward universal health coverage for all, a national health objective sensibly embraced by Uganda, Nigeria, and many other countries in Africa.

Little Hands Make Light Work – Why Handwashing Matters

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By Dr Angus Spiers, Deputy Director, Child Survival, PSI

Working in almost 70 countries means I spend a lot of time traveling and meeting people. A father of small children myself, I try to start my day in the villages I visit getting to know the lay of the land with the kids, kicking a soccer ball around, or just goofing off as kids like to do.

When it’s time to leave, I usually play one last game. About handwashing. Yes, handwashing…

Handwashing with soap is one of the most effective tools to stop the spread of disease, yet in many households worldwide it’s a low priority. Bathing, laundry and washing dishes are often higher on the list than getting kids to handwash with soap. Generally parents realize that handwashing is important, but what they don’t always know is that soap can help eliminate the diseases that can kill their children.

Poor hygiene contributes significantly to diarrhoeal disease, one of the leading causes of death and sickness among children below the age of five in Kenya. By ensuring that homes have access to clean water, decent sanitation and that kids practice proper hygiene, we can eliminate unnecessary sickness and death.

Many parents in the developing world view diarrhea as part of a normal childhood, so we must make a more direct connection for parents about disease and soap – see www.youtube.com/helpachildreach5.

Working with Unilever FoundationLifebuoy (the world’s number one germ protection soap) and the Government of Kenya, PSI implemented behavior change programs in schools and communities promoting handwashing with soap. The ‘School of Five’ program uses Lifebuoy soap products and specially-developed communication materials, enabling teachers and local health workers to help change behavior through fun handwashing programs and activities. Children learn that handwashing is important by making the process fun. Comics, games, handwashing diaries, reward stickers and posters encourage handwashing practice and provide kids with exciting talking points to share at home, at play, and in their communities.

It’s a method that PSI uses across the world – whether you call it ‘edutainment’ or ’social marketing’- it’s using lessons from the traditional marketing of products like a can of soda or a new movie to build interest for new products and services that promote healthy living.

Marketing tactics are used to inform people about the availability of a product, about adopting a new behavior and the difference that a service can make in their lives. Just as with a new bag or a new phone, appealing packaging and catchy messaging builds desire so that health consumers want to consume more.

Instead of just ‘wash your hands because I told you to’, the campaign helps makes handwashing a fun and desirable activity.

We use these techniques because we believe that markets, and the people who live within these markets, are a powerful force in the effort to end poverty. And that children are ideal agents of change (fellow parents, bear in mind the strength of ‘pester power’). Unlike a new bag of sweets, marketing healthy behavior within schools can translate to new knowledge and skills in the household and community-wide. That’s when we start to see real change.

To ensure our work in Kenya is sustainable, the program is part of the national-level school health policy – so there’s strong local ownership. Working within the education system to identify shared interests, exchange expertise, and promote handwashing with soap is critical for success.

Fewer cases of diarrhea and disease due to handwashing means more children reach their fifth birthday – a critical age when kids immune systems become strong.  When kids are healthy, they get an education and become productive adults, grow their local economies and ensure those markets remain strong for the future.

This is how we hope to build a better planet. Working with like-minded partners across the world, we can all help make handwashing second nature for kids.

After all, it’s something I instill in my own children every day.

Photo Credit: Jackie N. Presutti 2013

A Global Health Corps Member Starts Her Journey

By Melissa Mazzeo, Global Health Corps 

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I am surrounded by 105 other twenty-somethings at one of the most beautiful college campuses I’ve ever seen. Many of them have backgrounds similar to mine: public health with an international focus and a social justice bent. Others have followed completely different paths: computer science, economics, agriculture. But we share the belief that health is a human right and we are dedicated to ensuring equitable access to health care for all.

We are the fifth class of Global Health Corps fellows, on our way to yearlong placements at health organizations in Africa and the US. Our mission is to apply the skills we’ve developed in our academic and professional careers to improving health care delivery in resource-limited settings. It is a formidable task, but I am ready for it.

After college, I worked for three years at a global health organization in Boston. It was a great experience and I learned more about international development, social justice, and Microsoft Outlook than I ever could have in a classroom. But, after a while, I couldn’t help feeling detached, situated as I was in an office building thousands of miles away from the communities where the organization worked. I was developing skills and gaining knowledge, but I still felt like my understanding of the work was more intellectual than personal. I was inspired by the dedication and passion of my colleagues who worked in the field; I spent my time thinking and writing about global health equity, but they were living it. I wanted to live it, too.

Flash forward to Yale University: my apartment subletted, my passport renewed, and my two fifty-pound suitcases stuffed to the breaking point. My background in fundraising had paid off (pun intended) and I had been selected for a resource mobilization fellowship at Baylor College of Medicine Children’s Foundation, a pediatric HIV organization in Uganda. It’s exactly what I wanted – a chance to use my existing skills and to witness global health work being done first-hand – and I couldn’t be more excited about the challenge ahead of me.

Melissa is living and working in Kampala, Uganda for a year through a Global Health Corps fellowship. Her placement organization is Baylor College of Medicine Children’s Foundation – Uganda. During the year, she will be guest blogging about her experiences.

The Top 10 Global Health Moments in 2013

By Karl Hofmann, President & CEO, PSI

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The end of each year provides the opportunity to reflect on what transpired and what was accomplished. Global health saw plenty of victories and setbacks in 2013. Drug resistant TB, slowing donor funding, new outbreaks of polio and a devastating typhoon showed how easily progress can stall.

Amid these challenges emerged a changing global health landscape. The old way of doing things is now, more than ever, on its way out. In the next five years, the range of actors that are engaging and making a difference in addressing global health issues will continue to broaden and expand, even as the underlying health challenges narrow, and as The Lancet recently described, converge.

The infrastructure that developed over the last 50 years to tackle global development – the United Nations, donor agencies, international NGOs, other intermediaries and host governments – now finds itself working more and more with corporations, impact investors, next generation philanthropists, and socially networked individuals. This burgeoning ecosystem of development actors generates unprecedented attention and potential resources to address global poverty. Getting the roles right for these and other players might have a lot to do with whether we can end extreme poverty during our lifetime.

These are our top 10 moments for global health in 2013. Top 10 lists inevitably leave lots out. What did our global health and development leaders miss? Let us know what you think and share a few of your predictions for 2014.

1. Typhoon Haiyan

We include Haiyan not only for the unimaginable devastation it caused but as a reminder that when the media attention wanes and the world moves on, the health needs of the people affected will still be great.

“We will continue to serve these communities’ immediate needs, as well as long-term needs including child and maternal health; nutrition; water, sanitation and hygiene; and mental health services.” - Nancy A. Aossey, President & CEO of International Medical Corps

2. Malala Yousafzai’s Ripple Effect on Family Planning

The impact of Malala Yousafzai’s efforts on education is obvious, less so is the impact she will have on the reproductive health of girls and women. If Malala has her way, girls will not only be better educated, they will have healthier families, build stronger communities and contribute to more robust economies.

3. Polio Movement Celebrates Successes, Faces Setbacks

The world is watching how the polio community will overcome conflict and violence to eradicate polio by 2018.

4. Global Leaders Show Unprecedented Support for Maternal and Child Health

In September, The World Bank, UNICEF, USAID, Norway committed $1.15 billion over the next three years to advance progress toward Millennium Development Goals 4 and 5, and to get essential services and medicines to women and children who need them most.

5. Women Philanthropists Align for Health and Rights of Girls and Women

Women philanthropists are catalysts for new, innovative ways to deliver life-saving health products that will improve the lives of girls and women throughout the world. They are engaged and here to stay.

6. Gender-based Violence Movement Sees Tipping Point

World leaders acted on their commitments to eliminate gender-based violence, signaling a tipping point in the fight. Momentum is behind the movement. This is an issue to watch in 2014.

7. Under Mark Dybul’s Leadership, the Global Fund Is Back and Better than Ever

An impressive level of financial commitment from existing and new donor governments sends a strong signal.

8. Global USAID-Walmart Partnership Solidifies Long-Developing Trend

Public-private partnerships are not new. It is the magnitude of USAID’s partnership with Walmart that made us stand up and take notice.

9. Drug Resistance Threatens TB Progress, New Drugs Show Promise

By many measures the world is making great progress against TB – the rate of new cases has fallen worldwide and new drugs are in development – yet drug resistance seriously threatens that progress.

10. Women Deliver Conference Secures Bold Commitments for Girls and Women

More than 5,000 people gathered at Women Deliver in Kuala Lumpur, Malaysia, to promote the health of girls and women, adding additional momentum to what economists, government donors, philanthropists conclude: when you invest in the health of girls and women, you lift.

Read the latest edition of PSI’s Impact Magazine here.

Partnerships Help Defeat AIDS in Rwanda

By Dr. Anges Binagwaho, Minister of Health, Rwanda

The op-ed originally appeared in US News and World Report. It is based on an article she co-authored last week in the New England Journal of Medicine on the HRH program together with Paul Farmer, Eric Goosby and others. Available here.

binagwahoOver the past decade, we have made extraordinary gains against the world’s deadliest diseases thanks to the U.S. President’s Emergency Plan for AIDS Relief and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. These initiatives are saving millions of lives every year. In order to make these gains truly sustainable, we must now address a critical challenge in low-income countries: an acute shortage of highly-trained health professionals.

While Sub-Saharan Africa bears 24 percent of the global disease burden, it’s served by only 4 percent of the global health workforce. As the World Health Organization just announced, the global health worker shortage stands at more than 7.2 million today and is expected to grow to 12.9 million by 2035.

A report that my colleagues and I published in the “New England Journal of Medicine” offers compelling new evidence about the power of partnership in helping Rwanda, my country, to overcome this obstacle. The Human Resources for Health program – financed by PEPFAR and The Global Fund – is building health care worker capacity in Rwanda over the next seven years to ensure that we can meet the pressing health challenges facing our people.

World AIDS Day: Celebrating One Million

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By Donna Sherard, Deputy Director, Sexual, Reproductive Health and TB Department, PSI

Today, on World AIDS Day 2013, PSI and Alere are excited to announce that the one millionth HIV rapid test donated by Alere has landed on the ground in Zimbabwe. This moment is a cause for celebration as a further step toward achieving an AIDS-free generation.

Two years ago today PSI joined with Alere, a leading healthcare diagnostic company, to champion a commitment to increase access to rapid HIV testing. As part of this partnership, Alere donated one million HIV rapid tests as part of their ‘Make (+) More Positive’ campaign. The donation has aided 10 countries with the highest HIV prevalence and greatest need for tests in the world. The donation has also served to address critical gaps in test kit availability where PSI is the lead HIV testing provider.

PSI has worked to prevent and treat HIV and AIDS since the early days of the epidemic. In 1988, we began our first HIV prevention program in the Democratic Republic of Congo. Since then, PSI’s HIV prevention and treatment services have grown exponentially, and are now offered in over 60 countries around the world.

Together, through Alere’s state of the art rapid testing technology and PSI’s extensive distribution channels, these one million tests are helping people like Li*. For those who test positive, like Li and his wife, PSI provides the resources and support they need to live a full life.

“My wife and I have been injecting heroin for many years and we were both afraid that we might have been infected by HIV like many of our friends. We had heard about the Huxianghao Ba Clinic (HXH**) before but had never dared to go there. One of my best friends invited my wife and me to attend a gathering at HXH. During the party, an HXH staff member named Mei* talked to us about HIV and AIDS and asked us whether we would like to get tested, saying that we would know the results in just a few minutes. We both decided to do it.

My heart sank when Mei explained to us that both of our results were HIV positive. Mei then shared with us that she too, was HIV positive. She told us that at first she had a very difficult time accepting her status. Despite her fear of how others in her community would react, or how the disease would affect her livelihood, Mei sought counseling and treatment, and eventually joined PSI as a peer educator. That night, Mei talked with a smile about her current life, about her job, and about her family. She seemed to be positive about life and living with her status.

Remembering Mei’s story really helped my wife and me feel better about our positive status. We visited the doctor at the infectious hospital where Mei referred us. The doctor gave us a confirmatory test and a CD4 count test. We are now both seeking treatment and moving forward positively with knowledge of how to live with HIV. My wife and I will work together to stay healthy and face the future together.”

For people like Li and Mei and the countless others living with HIV, PSI and Alere will continue to work towards an AIDS-free generation, empowering others to stay healthy and face the future positively.

*Names have been changed to protect identities.

** HXH was formerly part of the PSI Clinical Health Network in China.

Two Steps President Obama Can Take to Defeat AIDS

By Desmond Tutu

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We are making historic progress against HIV/AIDS: The global rate of new HIV infections has leveled, and the number of annual AIDS deaths has decreased by nearly a third since 2005. Antiretroviral drugs are driving these gains by stopping progression of the disease and, we now know, preventing the spread of HIV infections.

Yet AIDS remains the leading cause of death in sub-Saharan Africa, where poverty limits access to lifesaving treatments and 25 million people are living with HIV—representing 70 percent of cases worldwide. President Barack Obama should be commended for uniting the world behind the goal of creating an AIDS-free generation. I share his passion and believe we can achieve this in the next decade—but only if we accelerate the provision of antiretrovirals to the poorest and most vulnerable people.

The opportunity has never been clearer. New data published in the New England Journal of Medicine project that early treatment with antiretrovirals in South Africa, my home country, would prove very cost-effective over a lifetime (costing $590 per life-year saved) and generate both public health and economic benefits. The World Health Organization now recommends early and preventive treatment with antiretrovirals, including administration to children and uninfected partners of people living with the disease. The WHO estimates that this could save an additional 3 million lives and prevent at least as many new HIV infections through 2025.

Making a Better Toilet with Social Franchising

By Shankar Narayanan, Director of Programs at PSI India

Credit: NY TimesI’d like to eat a burger. A chicken burger, mind you.

What if I had to go to a bakery for the bun, a butcher for the meat, a grocer for the lettuce, tomato and onion and a deli for the cheese?

By the time I put everything together, the lettuce has wilted, the bread is stale and the meat is looking a bit funny. To top it all off, I’ve never even made a chicken burger before and I’m not sure of how to cook it.

That’s what it’s like buying a toilet in Bihar.

Over 60% of India’s population does not have access to a toilet, meaning they are forced to defecate outside, a practice which causes the spread of diarrheal disease and contamination of the environment. PSI partnered with the NGOs Monitor Group, PATH and Water For People to answer the question: “Why don’t households have toilets?”.

We found that the supply chain is fragmented.

A Winning Strategy: Investing in Local Heroines

By Karl Hofmann, President & CEO, PSI

When you invest in local heroines, women win.

Despite all the systemic challenges women and children face around the world, we’ve learned that investing in local heroines who provide education and resources can help tear down barriers and save lives.

Here is an impact primer that shows how investing in local heroines helps PSI get results for women and children.

Local heroines trained in community health services save children’s lives.In many countries, mothers are unable to access health care for their children to treat preventable but deadly diseases like malaria, pneumonia, and diarrhea. We can shift that equation by deploying local health workers. In Cameroon, 48% of children received diarrhea treatment in areas served by community health workers vs. 7% of children in other areas with no community health workers.

Local heroines are effective champions for social change.There is often stigma associated with family planning activities. In Zimbabwe, where women are embarrassed to purchase female condoms, local heroines like hairdresser Tears Wenzira are distributing them in beauty salons. In fact, more than one million female condoms are distributed through this network of 2,500 hairdressers across the country.

Local heroines help keep mothers alive during childbirth.In the next 24 hours, 931 women will die worldwide from preventable pregnancy-related causes. In Pakistan, more than three-quarters of births take place at home, which is high-risk for maternal mortality. A pilot voucher program – where trained outreach workers recruit pregnant women from low-income households to receive subsidized reproductive health services from private health providers – increased prenatal clinic care by 16%, health care-facility based deliveries by 20% and postnatal care by 35%.

As you can see, PSI is committed to measuring our impact. And we’ve learned that investing in local heroines provides extraordinary returns on your investment.

Will you invest in a local heroine?