The Daily Impact: Philippines Reconstruction Could Cost a lot More

January 10, 2013

The cost of typhoon reconstruction this year could reach $3.1 billion, more than 50% higher than initially estimated, as the Philippines seeks to build back better and put in safeguards for future disasters. From Reuters:

The total cost of a four-year reconstruction effort may also end up steeper than the current estimate of 361 billion pesos, Florencio Abad said.

Typhoon Haiyan, one of the strongest storms to make landfall anywhere, reduced almost everything in its path to rubble when it swept ashore in the central Philippines on November 8, killing at least 6,190 people, leaving 1,785 missing and 4 million either homeless or with damaged homes.

“The plan was 90 billion (pesos) for the year, but I think it will be more,” Abad told Reuters in his Manila office, adding typhoon-related spending would reach 138 billion pesos.

“I don’t think they (reconstruction planners) have factored in the need to introduce resiliency. So that will be 10-30 percent more.”

Apart from the immediate need for temporary shelter, providing jobs and restoring water, health and sanitation services, the government underestimated other costs, including that of identifying and documenting the dead before they are buried.

“There is an international standard for doing it, before you bury them, that wasn’t factored in. That’s a lot of money already,” Abad said, adding the government could adequately finance a higher post-typhoon spending bill this year.

Manila has set aside funding of 54 billion pesos for the rebuilding effort from a supplemental budget passed late last year, this year’s national budget, savings, calamity and other funds. At least 80 billion pesos more would come from concessional loans offered by the World Bank, Asian Development Bank and the Japan International Cooperation Agency.

“We can fund it. The question is can we absorb it? That is why we have to start early,” Abad said.

Going forward, the Philippines, which is hit by an average 20 typhoons a year, is considering not only building typhoon-resilient structures but also permanent evacuation centers equipped with generators and supplies – an initiative that wasn’t part of initial plans.

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Global Health and Development Beat

Family Planning - Women in China are being forced into abortions due to the nation’s population limit policies.

E-Health - A project in Zambia is connecting people who have no access to doctors to medical professionals on the other side of the world.

South Sudan - A ceasefire is urgently needed so that aid agencies can take medicine, food, plastic sheeting and other emergency supplies to tens of thousands of civilians trapped by fighting in South Sudan, say groups on the ground.

Respiratory Health - The Chilean government issued a public health warning regarding the threat posed by recent forest fires. (in Spanish)

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The Players

MSF - Says the conditions are dire for the roughly 75,000 South Sudanese seeking shelter along the Nile.

FEWS-Net - Issued a new warning of a potential food crisis in parts of South Sudan, due in part of the recent conflict.

UNICEF - Is supporting health officials in Liberia who are launching a campaign to vaccinate some 100,000 children against pneumonia.

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Spotlight on PSI

HIV/AIDS - PSI sponsored theater performances in Zimbabwe over the past year to support the growth of the Association of Community Theatre Artists and shows that targeted HIV/AIDS prevention.

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Buzzing in the Blogs

A Gates Foundation-supported concept aims to package and brand condoms that women will buy. From Fast Company:

Mine products are packaged in such a way that women will feel more comfortable having them out on their bedside table or in their grocery bags,” says Mansi Gupta, one the students involved in the project. “We hope to encourage more women to buy condoms, thus adopting healthier sexual behaviors.”

At the start of their project, Gupta, Emi Yasaka, Willy Chan, and Rona Binay surveyed 207 people (70% women) to understand their feelings about condoms. Three-quarters (77%) said they felt embarrassed buying the product, while 60% said they believed women who carry condoms are promiscuous.

The students decided to create packaging that’s less male-oriented, as you can see from the slide show. They also designed refillable bedside holders, and a tube that houses condoms and tampons together. Pairing condoms with everyday products should reduce the potential for embarrassment, they figured.

“If condoms currently make women feel like they are not the target audience and they should not be buying them, Mine is aimed to oppose that feeling and change that stigma,” Gupta says.

The Centers for Disease Control and Prevention, which wants to see a “positive shift in women’s sexual health,” set the challenge for the SVA team. Gupta says the CDC may help make Mine a commercial reality, possibly by working with existing condom or female hygiene companies. But first the students need to do more testing, and get feedback on what they’ve come up with so far.

It may take more than packaging to change stereotypes, but getting women more involved in sexual health ought to be an idea that pays dividends.

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Capital Events

Happy Friday!

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By Mark Leon Goldberg and Tom Murphy

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Dybul and Frenk Urge Engaging Emerging Powers to Propel Development

As the deadline approaches for the Millennium Development Goals, now is a time to reconsider how to engage with developing countries. Global Fund head, Dr Mark Dybul and dean of Harvard’s School of Public Health, Dr Julio Frenk, say that it is time actually move to the reality of shared responsibility and mutual accountability.

The problem is the status quo does not foster such cooperation. They call for a new consensus that moves away from reaction to paternalism and towards shared responsibility and mutual accountability. Their ideas are summed up in a blog post for the Huffington Post.

Principles might include: reaffirmation of the basic principles of shared responsibility and mutual accountability; a commitment to support and participate in the planning processes and funding priorities of low- and middle-income countries rather than create parallel engagement; focusing investments globally or in regions or countries of particular interest as co-investors with other development partners under national strategies; technical exchange, and; over time, increasing participation as a funder of multilateral organizations that recognize the importance and unique roles of the emerging powers in their governance structures.

They argue that it is the emerging powers, countries who have successfully moved away from the grips of poverty, that can share their experiences and knowledge with countries that remain behind. It puts a country like India and China in a much better position that the US and UK to support, teach and learn from countries like Zambia and Sierra Leone.

One way the emerging powers can participate is by expanding their investments in organizations like the Global Fund, say Dybul and Frenk.

But we should not expect emerging powers to simply adapt to existing models of development. They may generate their own models, which the rest of the world should welcome and support. And collectively, those of us in the development community should think hard about how we — in our models and institutions — must evolve to embrace and promote the emerging powers’ potential for effecting positive impact regionally and globally. We will also need to imagine and create new, structured ways of measuring and encouraging accountability around new models and principles.

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Progress and Problems in Smoking Cessation Effort

Capture

There is some good news and some bad news about global smoking rates.

The global percentage of smokers is decreasing. That is exciting.

However, the total number of people smoking and the number of cigarettes sold continues to increase. That is bad.

Those are the findings of new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The study, “Smoking Prevalence and Cigarette Consumption in 187 countries, 1980-2012,” published yesterday in the Journal of Medical Association, shows a significant decline in smoking prevalence since 1980.

“Tobacco control is particularly urgent in countries where the number of smokers is increasing,” said Alan Lopez, Laureate Professor at the University of Melbourne. “Since we know that half of all smokers will eventually be killed by tobacco, greater numbers of smokers will mean a massive increase in premature deaths in our lifetime.”

The rate of smoking for men fell by 25% since 1980. Women fared better, reducing smoking by 42% over the same period of time. Stand out countries for low smoking rates for men are Antigua and Barbuda, Sao Tome and Principe, and Nigeria. The lowest rates for women are in Eritrea, Cameroon, and Morocco.

However, problem countries like Russia, Indonesia and Timor Leste face a population where more than half of all men smoke.

“Despite the tremendous progress made on tobacco control, much more remains to be done,” said IHME Director Dr. Christopher Murray. “We have the legal means to support tobacco control, and where we see progress being made we need to look for ways to accelerate that progress. Where we see stagnation, we need to find out what’s going wrong.”

tobacco-screenshot

Alongside the research, IHME published some interactive data about smoking prevalence in 2012 and changes overtime. Seen in the screenshot above, users can look at the number of smokers by region, gender, age and country. It helps show how much progress has been made and illustrates which countries are still behind and the sea of blue that constitutes the still relatively low rates of smoking across Africa.

Progress has been made, but there is still a ways to go.

“Change in tobacco prevalence typically has been slow, underscoring what a hard habit it is to break,” said Emmanuela Gakidou, Professor of Global Health and Director of Education and Training at IHME. “But we know from these global trends that rapid progress is possible. If more countries were able to repeat the success we have seen in Norway, Mexico, and the United States, we would see much less health loss from smoking.”

 

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The Daily Impact: Food Aid Reaches 10,000 in CAR

January 9, 2013

Aid agencies are trying to distribute food aid and other assistance to an estimated 100,000 displaced people living in makeshift tents at the airport in Bangui, Central African Republic. From VOA:

5D086912-8861-41FF-AD2C-2AF9E8BCCC2E_mw505_mh360_sA spokesman for the UN refugee agency, Bernard Ntwari, said that distributing aid at this densely populated camp has been difficult.

He said the distribution of food had to be suspended here several times because of a lack of security, but now, with collaboration from the displaced people’s leaders, they have been able to clear a site for the operation.

The distribution of food and other essentials, such as buckets for water and waterproof mats, was restarted Tuesday and is due to last for 10 days.

An experienced aid worker told VOA he had never seen a camp where people were packed together so tightly, a sign of how desperate they are to get close to the French army’s protection.

The aid agencies are urgently seeking an alternative site for some of the displaced to avoid health risks from overcrowding.

Since last year, the World Food Program has been distributing food in three areas of the Central African Republic where many people have fled violence: Bangui and the towns of Bossangoa and Bouar, areas where ex-president Francois Bozize, who lost power in a coup last March, still commands strong support.

However, there are many other parts of the country where people have fled their homes. The U.N. refugee agency has said there could be nearly 1 million displaced people in the C.A.R.

Ingela Kristiansson, who reports on the distributions for the World Food Program, said getting access to some of the displaced is a challenge.

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Global Health and Development Beat

Maternal Mortality - Once sidelined by government programs, midwives are being welcomed into the push to reduce maternal deaths in India.

HIV/AIDS - Concerns with the general disarray of South Africa’s HIV/AIDS treatment program, voiced by activists and medical professionals.

Flu - Doctors are unsure why the H1N1 flu strain is targeting young, healthy adults.

Cholera - Two dozen people with cholera in Namibia’s Kunene Region were hospitalized from a recent outbreak.

TB - Smartphones are unlocking access to patients with TB and helping to track cases, in the US.

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The Players

MSF - Says it it is vaccinating some 68,000 children in the Central African Republic camps against measles.

UN - More than 38,000 people appealed to the UN for help after facing sexual assault or other gender-based violence in Syria in 2013.

UN - The UN warned that the area in Iraq’s Anbar province is facing a “critical humanitarian situation” as food and water supplies are starting to run out.

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Spotlight on PSI

HIV/AIDS - PSI will implement a Global Fund grant for HIV/AIDS services in Tanzania.

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Buzzing in the Blogs

Dr Christopher Johnson explains the economic cost of measles, in the KevinMD blog. He writes:

The measles virus is among the most infectious of all know viruses, with an attack rate of well over 90%. That means that over 90% of susceptible people — those who have not been vaccinated or who have not had the disease — will get it if exposed. I’ve seen one case, and that was thirty years ago, although my parents showed me a picture of what I looked like with measles in 1958.

Before the introduction of a vaccine in 1963 measles caused about 4 million cases annually in the USA, leading to 48,000 hospitalizations and 500 deaths. That’s a lot of kids in the hospital and a significant mortality. The measles vaccine has nearly eliminated these things, but not entirely. I recently ran across an interesting article from a couple of years ago that investigated  a measles mini-epidemic that happened in Southern California. One thing that caught my eye, something I had not considered before, was the economic cost of the epidemic.

The outbreak happened when an unvaccinated seven-year-old child returned from Europe after being exposed to measles there, and proceeded to expose other children. Like many viruses, people who are infected shed virus before they know they are sick; think of it as a crafty strategy the virus uses to spread itself.

Although 879 people were exposed, most of these were vaccinated so only 12 secondary cases occurred, all in unvaccinated children. Nine of these children were deliberately unvaccinated, but three of them were too young to have received the vaccine. One three-month-old had to be hospitalized. Forty-eight children too young to be vaccinated had to be quarantined at home for several days.

The authors estimated the economic costs of the entire epidemic, including lost work time for parents, costs of treatment, and time spent by the health department investigating it, at nearly eleven thousand dollars per case. So besides saving lives, measles vaccine reduces healthcare costs significantly.

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Capital Events

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy; Photo Credit: AP

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Little Hands Make Light Work – Why Handwashing Matters

Lifebuoy_2_homepage

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

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The Daily Impact: Cancer Rates Fall Across the US

January 8, 2013

A decline in smoking in America has contributed to the decrease in cancer rates across the country, finds a new American Cancer Society report. From Al Jazeera:

The report, an annual forecast of the number of new incidences of cancer and how many people are expected to die of it in the coming year, said that of particular note was figures that suggest black men saw the most dramatic declines in cancer death rates in the last 20 years, with a 55 percent decrease among those between the ages of 40 and 49, and significant drops in every other age group.

Black men have historically fared the worst among all demographic groups in terms of cancer deaths – they die of cancer about twice as often as Asian-Americans, for example. But because many black people picked up the habit of smoking cigarettes and other tobacco products at much lower rates than white people did starting in the late 1970s, they have a much lower prevalence of lung cancer today, according to Rebecca Siegel, an epidemiologist at the American Cancer Society and co-author of the report.

Even so, black Americans still have higher cancer death rates than white Americans do, and that’s likely because of socioeconomic differences, the report suggests.

“Cancer death rates are associated with access to care,” Siegel said. “Individuals who have lower socioeconomic status have much higher death rates than more affluent individuals,” who are more likely to have health insurance, engage in exercise and more easily access healthy foods like fruits and vegetables, all of which decrease cancer risks.

In particular, people who don’t have health insurance or who are on Medicaid are more likely to be diagnosed with advanced cancer, which is much harder to treat than cancer that is detected early. Census data has shown that 20 percent of black Americans are uninsured, as compared to 11 percent of whites.

Vanessa Sheppard, an oncology professor and assistant director for health disparities research at the Georgetown Lombardi Comprehensive Cancer Center, said race-based differences in cancer death rates are caused by a complex mix of behavior, biology and access to health care. “Race is a marker of the experience that one brings,” she said.

For example, black women are less likely to survive breast cancer than white women, a problem that was brought about by a lack of access to health care following advancements in detection. “There was a time in the U.S. where we really didn’t have some of the racial disparities that we see now,” she told Al Jazeera. Before there were screening techniques like mammography, black and white women died of breast cancer at similar rates, she said.

Sheppard said black Americans have also experienced higher cancer death rates because of an increased likelihood of hypertension, heart disease, diabetes and other obesity-related diseases. “We need attention to diet and exercise,” she said. “It is something that’s low cost. You don’t have to get a prescription for it. We need intervention at the policy level and also at the individual level to empower people to make healthy choices for their diets.”

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Global Health and Development Beat

CAR - More than 2 million people in the Central African Republic are in need of assistance, accounting for roughly half of the nation’s total population.

HIV/AIDS - The majority of HIV positive mothers in Swaziland do not receive ARV treatments while breastfeeding, putting their children at risk of contracting HIV.

Family Planning - Despite donor funding to advance Myanmar’s healthcare system, experts say more work is needed in life-saving family planning services, which have yet to receive the support they need.

Measles - As the Philippines tries to understand the current measles outbreak, one theory is the displacement of people by Typhoon Haiyan contributed to the spread of the disease.

Nodding Disease - A reported drug shortage in Pader, Uganda for children suffering from Nodding disease.

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The Players

WFP - WFP and the UNHCR launched an effort to scale up emergency food distribution to thousands of displaced people in the Central African Republic.

UN - Refugees from the Central African Republic have released two UN workers in Cameroon – taken hostage to protest a lack of needed aid.

Save the Children - Joined UNICEF, USAID and other organizations to encourage global leaders to be the champions for the children of Syria and outlined a $1 billion strategy.

USAID - Unveiled its new program to address obstetric fistula, Fistula Care Plus a five-year cooperative agreement with a ceiling of $74.49 million.

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Spotlight on PSI

PSI’s own Dr Angus Spiers describes the importance of handwashing for child health. He blogs in Business Fights Poverty:

Working with Unilever Foundation, Lifebuoy (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.

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Buzzing in the Blogs

Center for Global Development head Nancy Birdsall shares here ten wishes for 2014. Here are a few highlights:

1. Bloomberg, Bono, and Bill Gates team up on tobacco control

Three proven champions of global health and development collaborate on a global anti-smoking initiative. Why does this top the list? Because it’s really big and not hard to fix. Smoking is the leading cause of preventable death in the world, and if current trends continue it will kill one billion people this century, 10 times more than the 100 million it killed last century. Higher tobacco taxes are a proven deterrent to smoking.

While I’m at it, I’m wishing that Jim Kim, the first physician to serve as World Bank president, takes up the cause and forges an agreement among all multilateral development banks that by the end of 2014, fiscal experts advising member countries on revenue mobilization will offer support and encouragement to raise taxes on tobacco, consistent with the WHO Framework Convention on Tobacco Control. The US, unable to lead, at least stays out of the way. (HT: Bill SavedoffAmanda Glassman; see here for a COD Aid approach)

8. The WHO and the FAO work together to slow resistance to antibiotics

Leaders in the World Health Organization and the Food and Agricultural Organization work with member countries to set global rules for managing use of antibiotics, starting with strengthening and implementing standards for monitoring and reporting antibiotic use in livestock (of the World Organization for Animal Health) in the major livestock producing countries, so that links to antibiotic resistance can be assessed (HT Kim Elliott). (See here on the FAO and global public goods and here on the looming problem of drug resistance and the collaborative efforts needed to overcome it.)

9. International institutions become more legitimate and representative—starting with women

As Garth Luke pointed out in a comment on my call for ideas, “we have been talking about greater gender balance at the UN and in national governments for many years but progress has been too slow.” I also like Garth’s solution: the G-20 members agree that all delegate positions above a certain level will alternate between male and female incumbents. This is not just about gender equity for equity’s sake! There is solid evidence that diversity of any sort encourages smarter decision-making, and that the inclusion of women in particular improves the functioning of deliberative bodies.

While we are at it, let this be the year when the Europeans and the United States announce they will not insist that the next head of the IMF be a European and the next head of the World Bank be an American.

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Capital Events

Wednesday

9:00 AM - Stories to Watch 2014 - World Resources Institute

12:00 PM - Beneficiary Feedback—Key to Accountability in International Development

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy

Sign up on the right-hand column to receive the Daily Impact in your inbox each morning!

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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.

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The Daily Impact: Hope Amid HIV/AIDS Cure Setback

January 7, 2013

The return of HIV in two patients believed to have been cured is a setback, yet promising development in the effort to cure HIV and AIDS. From Reuters:

True, the news hit hard last month that the so-called “Boston patients” — two men who received bone marrow transplants that appeared to rid them completely of the AIDS-causing virus — had relapsed and gone back onto antiretroviral treatment.

But experts say the disappointment could lay the basis for important leaps forward in the search for a cure.

“It’s a setback for the patients, of course, but . . . the field has now gained a lot more knowledge,” said Steven Deeks, a professor and HIV expert at the University of California at San Francisco.

He and other experts say the primary practical message is that current tests designed to detect even very low levels of HIV in the body are simply not sensitive enough.

As well as having the human immunodeficiency virus (HIV), the Boston patients both also had a type of blood cancer called lymphoma, for which they had bone marrow transplants — one man in 2008 and the other in 2010.

They continued taking antiretroviral AIDS drugs, but eight months after each patient’s transplant, doctors could not detect any sign of HIV in their blood.

In the early part of 2013, both patients decided to stop taking their AIDS drugs and both appeared to remain HIV-free, prompting their doctors at Boston’s Brigham and Women’s Hospital to announce that they may have been cured.

Yet in December came news that one of the men had begun to show signs of an HIV rebound by August, while the second patient had a relapse in November.

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Global Health and Development Beat

Malaria - A new rapid malaria test can determine whether a person has malaria without drawing blood, say researchers.

WASH - Nigerian officials are handing out fines to anyone who defecates in open spaces such as forests.

Polio - Some good news on the polio vaccine effort in Pakistan. A three-day campaign started in the Bajaur Agency on Monday.

CAR - The situation in the Central African Republic continues to worsen, but aid is experiencing a hard path to reach people in need.

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The Players

WHO - Says the fight against malaria has slowed, in a recent report, citing the decline in bednet purchases.

MSF - Says it’s been forced to drastically reduced its medical activities in Bangui airport, Central African Republic, following two days of shooting close to MSF’s clinic at the airport.

Japan - Announced the provision of nearly $100 million in additional aid for Burma to support the country’s peace process.

Europe - The Guardian published a new interactive map of Europe’s development agencies with information about each group.

ECHO - Warns of the problems caused by health disruptions in the Central African Republic for the people who have not been displaced.

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Buzzing in the Blogs

Mission creep in the development sector has seen efforts to improve the conditions of people around the world, lose focus and efficacy. Mark Bellemare makes the case in Foreign Policy and discusses how to get things back in order. He writes:

The development landscape has never been more cluttered than it is today. International organizations such as the UN and the World Bank work side by side with national agencies such as the US Agency for International Development (USAID), nongovernmental organizations such as Oxfam and World Vision, and philanthropies such as the Clinton and Gates foundations. As the number of actors has grown, the definition of development has expanded, leading many in the field to emphasize peripheral goals far removed from the concerns of the world’s poorest. On the New York Times blog edited by Nicholas Kristof, a post titled “Three Things the Development World Could Do Better” put promoting breastfeeding at the top of the list. Some groups even specialize in sending leftover hotel soap to Africa (the Global Soap Project, a partnership with the Hilton hotel chain), teddy bears to tuberculosis-afflicted children (Teddies for Tragedies), and clowns to people in crisis areas (Clowns Without Borders).

But it is not just pundits and those working for niche charities who are shoehorning extraneous goals into the category. Many experts and policymakers consider the following goals among their top priorities: providing universal primary education; promoting gender equality; improving maternal health; and developing “a global partnership for development.” If those aims sound familiar, it is because they are: they are some of the so-called Millennium Development Goals, which the UN announced in 2000 and never really had a chance of achieving by its deadline of 2015. Other organizations have adopted similarly broad agendas. USAID, for example, promotes things as diverse as an independent media, government transparency, cookstoves, ecotourism, and political reconciliation forums.

In all fairness, it is true that the causes of underdevelopment — the market failures leading to persistent poverty — are many and interrelated, so tackling just one problem is highly unlikely to lift villages out of poverty, not to mention regions or entire countries. There are no silver bullets, which is why many development specialists were skeptical of the microfinance fad after Muhammad Yunus and the Grameen Bank shared the Nobel Peace Prize in 2006: even if one could completely eliminate credit market failures by making small loans to the poor, many other market failures would remain that would constrain development. A loan to a poor single woman might allow her to buy a sewing machine and start her own clothes-mending business, but in the absence of insurance markets, she still faces the risk of having to sell off all of her assets (including her sewing machine) to pay for the medical treatment of a sick child.

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Capital Events

Wednesday

9:00 AM - Stories to Watch 2014 - World Resources Institute

12:00 PM - Beneficiary Feedback—Key to Accountability in International Development

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy

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Soap will Save Lives, Brands will Increase Use

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Brands might not sound like something that matters for global health. With the approaching Super Bowl, brands are thought of the things that come up with clever commercials to entertain and sell products.

However, that is exactly why they are important when it comes to behavior change, says Sami Singh, Global Brand Vice President for Unilever-Lifebouy. He argues that brands are what grab attention and get people to take action. For example, handwashing is a simple and important way to improve the health of everyone, especially children. Just like Coca Cola and Pepsi will compete to make their cola look cool, soaps should appeal to the everyday consumer.

Then, people will want to buy and use the soap. It is the brand that will help affect change. The soap matters a whole lot, but it has to literally get into the hands of people if it is to have an impact.

That is where brands can make a difference.

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The Daily Impact: Afghanistan Faces Inexplicable Hunger Crisis

January 6, 2013
A worsening hunger crisis is developing in Afghanistan and the reasons are under dispute. From the New York Times:

Afghan hospitals like Bost, in the capital of war-torn Helmand Province, have been registering significant increases in severe malnutrition among children. Countrywide, such cases have increased by 50 percent or more compared with 2012, according to United Nations figures. Doctors report similar situations in Kandahar, Farah, Kunar, Paktia and Paktika Provinces — all places where warfare has disrupted people’s lives and pushed many vulnerable poor over the nutritional edge.

Even the capital has seen an increase. “In 2001, it was even worse, but this is the worst I’ve seen since then,” said Dr. Saifullah Abasin, head of the malnutrition ward at Indira Gandhi Children’s Hospital in Kabul.

Reasons for the increase remain uncertain, or in dispute. Most doctors and aid workers agree that continuing war and refugee displacement are contributing. Some believe that the growing number of child patients may be at least partly a good sign, as more poor Afghans are hearing about treatment available to them.

What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.

Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.

Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.

One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.

Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.

Now, M.S.F. is planning to open five satellite clinics with intensive feeding programs in Lashkar Gah to take the pressure off the overcrowded hospital.

Despite the increase in the malnutrition caseload, doctors and health officials are not sure there has actually been a sharp rise in child malnutrition that can be attributed to any single factor.

“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.

In part, expansion of the hospital’s facilities has acted as a magnet, drawing more cases, Mr. Vandormael said. Unlike at other public hospitals in Afghanistan, patients and their caregivers do not have to pay for their own medicine and food at Bost. And M.S.F. has been able to ensure that it gets regular deliveries of Unicef-provided therapeutic foods used to treat malnutrition.

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Global Health and Development Beat

Poverty - The 50 year war on poverty in the US has produced a mixed bag of results, reports the New York Times.

The Plague - Officials confirm new cases of the bubonic plague in Peru. (in spanish)

Polio - A report from the Inter Press Service describes how the Taliban is a stumbling block to polio eradication in Pakistan.

Measles - The measles outbreak in the Philippines is a threat to many parts of metro Manila, warns the Department of Health.

Polio - Polio vaccines remain on hold due to a lack of agreement between political administration officials and polio workers in Pakistan’s Khyber Agency.

Flu - Reports of a human case of the H7N9 flu in eastern China.

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The Players

World Bank - Questions are being asked over whether World Bank activities in Honduras are causing more harm than good.

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Buzzing in the Blogs

A New York Times board editorial remarks on the health crisis in Syria. They write:

Immunization coverage in what are now mainly opposition areas was already below accepted standards in 2011, but the situation has deteriorated. Data on routine immunization from the World Health Organization reveal that over the past two years a large proportion of the Syrian population has gone without vaccination.

Across Syria, coverage went down to 60 percent in 2012, and was as low as 50 percent in the embattled eastern city of Deir al-Zour, a front line between government and rebel forces. The latest W.H.O. figures from 2013 show that the level is now down to 36 percent in largely rebel-held Deir al-Zour Province, although it has remained at 100 percent in government-controlled areas such as the western stronghold of Tartus.

Given these conditions, it was no surprise to medical practitioners that a polio outbreak occurred. The question is why the international community did not prepare better for this eventuality. A disturbing part of the answer is that the United Nations itself has aggravated the situation.

Like other United Nations agencies, the World Health Organization works directly with the Syrian government. The W.H.O.’s Syria office is in the Ministry of Health building in Damascus; many of its staff members are former ministry employees. A recent Reuters report on how the Assad government uses red tape and threats to prevent the provision of aid in opposition areas has raised doubts about the ability of the W.H.O. to act with impartiality.

The W.H.O., working with the Syrian government, excluded Deir al-Zour from a polio vaccination drive that began in December 2012. According to the W.H.O., the province “was not included in the campaign as the majority of its residents have relocated to other areas in the country.” Ten months later, this was the province where polio re-emerged.

There is no evidence that most of the province’s one million residents had, in fact, migrated. The United Nations World Food Program continued to distribute food there throughout 2012 and 2013 (with occasional interruptions because of worsening security conditions). In December 2012, the agency reached 69,000 people in Deir al-Zour.

Last month, an investigation by the German weekly newsmagazine Der Spiegel charged the W.H.O. with obstructing the testing of polio samples from the Deir al-Zour region. These samples had been presented by an agency working under the aegis of the Syrian National Coalition. It took nearly a month to get the test results — positive for poliomyelitis — and then only from an independent provider in Turkey. By that time, thousands of displaced people had moved within Syria or fled as refugees to neighboring countries, most likely spreading the disease.

The latest draft of a W.H.O. situation report for Syria reveals that it took three months for the W.H.O. and the Syrian Health Ministry to confirm a polio case detected in Aleppo in July 2013. It was then some weeks before a nationwide vaccination campaign began.

The consequences of these delays and failures now reach well beyond Syria’s borders. Lebanon and Jordan, where a large proportion of Syrian refugees have fled, are particularly at risk. Their public health systems are already overloaded and underfunded. Unicef figures for immunization from the Lebanese Health Ministry indicate that only 77 percent of the population had been routinely covered for polio in recent years, placing thousands of Lebanese children at risk. “If the Unicef figures are correct, then this would be far too low to keep an introduced infection at bay,” said Professor Martin Eichner, a disease expert at the University of Tübingen, Germany. “With 4,000 Syrian refugees a day leaving the country, and the majority entering Lebanon, the virus is already in Lebanon or they will get it sometime soon.”

There is also no discernible plan for delivering vaccination coverage to the hundreds of tented settlements that house as many as 200,000 Syrian refugees across Lebanon.

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Capital Events

Monday

3:00 PM - Korea’s Growing Influence in the Global Economy

Wednesday

9:00 AM - Stories to Watch 2014 - World Resources Institute

12:00 PM - Beneficiary Feedback—Key to Accountability in International Development

Thursday

10:00 AM - Humanitarian Crises in 2013: Assessing the Global Response - Brookings

2:00 PM - Subcommittee Hearing: Will there be an African Economic Community? - Congress

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By Mark Leon Goldberg and Tom Murphy

Sign up on the right-hand column to receive the Daily Impact in your inbox each morning!

Read More