Archive for March, 2013

Death by Sequestration

March 18, 2013

Across the board cuts in US funding for almost everything government does (except the salaries of members of Congress!), will have effects on people’s lives. Damage from sequestration is reported daily. Even civil rights are threatened as reported in the Washington Post in a story that highlights the plight of poor people who must remain jailed because funds for public defenders have been cut and there are not enough lawyers to ensure a speedy trial.

amfAR, The Foundation for AIDS Research, has been tracking the potensequestration-infographic_031113 malaria part smial effects of the sequester on global health programs of the US Government. amfAR has made estimates based Congress’ action in January 2013, and reported that, “The Office of Management and Budget (OMB) has calculated that, as of March 1, 2013, funding for non-defense discretionary programs must be cut across the board by 5.0 percent.1 As we found in our earlier calculations, applying sequestration cuts to US government global health programming will have minimal impact on deficit reduction, but will be devastating to the lives of many thousands of people globally.”

sequestration-infographic_031113-malaria-part-sm.pngHere are the specifics on malaria programs:

1.16 million fewer insecticide-treated mosquito nets will be procured …
leading to over 3,000 deaths due to malaria
1.9 million fewer people will receive treatment

InterAction and Global Communities have produced an informational graphic that summarizes the impact on disease control, nutrition and education (see malaria section to right). This comes as part of a general leveling and possible downturn in malaria funding over the past few years. It will be hard to sustain the scale-up in malaria interventions that has been achieved since the United Nations called for universal coverage in 2009.

Most of the decision makers who vote on funds to curb global disease scourges will not likely ever see a case of malaria, much less experience one. Hopefully this does not mean that they will be immune to advocacy to prevent needless deaths from malaria and other causes of maternal and child mortality.

Reposted from: http://malariamatters.org/?p=1600

March 17, 2013

SBFPHC Policy Advocacy

www.singlemindedwomen.com

The obesity rate among Mexican school-aged children rose from 18.4% in 1999 to 26.2% in 2006, and it is estimated that over 69% of the country’s population over the age of 15 is overweight. Type 2 diabetes is now the leading cause of death in the country.  Mexico leads the world in soft-drink consumption with an average of 43 gallons consumed per person per year.

In response, the government has instituted a ban on the sale of soft-drinks and junk food in public schools as well as an increase in the number of hours of physical education from one to three per week. The government has also begun an after-school diet and exercise program in which children can exercise and learn about preparing and eating healthy foods.

However, regardless of the ban on selling junk food and soda inside schools, vendors still gather outside many schools and…

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Making Misoprostol widely available for home births in Afghanistan: New policy initiative

March 13, 2013

afghanistan pregnant mother

Photo A pregnant Afghan woman in rural Afghanistan

 

Afghanistan has one of the highest maternal mortality rates in the world. A mountainous environment combined with extreme weather conditions, extreme poverty, an almost 40 year history of ongoing conflict, conservative culture, and a nascent government have led to a country where qualified human resources in health are scarce. In addition, the above mentioned contextual factors have contributed to a state where more than 90% (estimated) of births take place at home.

Having worked in Afghanistan on a health systems strengthening evaluation project gave me a unique opportunity to witness some of the less visible realities. Most health facilities only carried Oxytocin whereas Misoprostol was hardly stocked.

Postpartum hemorrhage is by far the leading cause of maternal deaths worldwide. The lack of skilled health workers to properly administer an uterotonic creates an immense gap for all those who deliver at home without the use of a skilled birth attendant.

Various reputed international and national stakeholders (FIGO, ICM, RCOG, American Congress of Obstetricians and Gynecologists, and Afghan Midwives Association) have come out in support of Misoprostol as a viable option for preventing postpartum hemorrhage despite lack of sufficient evidence cementing its efficacy.

Research in Afghanistan has shown that community distribution of Misoprostol is safe and effective, and currently a clinical trial regarding the efficacy of Misoprostol is underway in Afghanistan. National policy makers are urged to forge ahead with new policy to mandate Misoprostol be effectively and comprehensively distributed nationally by front-line health workers, especially as countries such as Rwanda, Burundi, Angola, and Uganda have done so successfully for the last few years.

 

New mother in Afghanistan

Photo A new Afghan mother and her baby

Low Routine Immunization Coverage in Nigeria: Decay at the Foundations.

March 12, 2013

In April, 2001, the city of Abuja, Nigeria welcomed delegates from countries of the African Union. These leaders made a declaration at the meeting to set a target of an allocation of 15% or more of their budget to the health sector. That was 12 years ago. The Nigerian budget for 2013 allocates 6% of funds to the health sector drawing reactions from the Medical and Health Workers Union of Nigeria (MHWUN). The poor attention accorded the health sector in terms of government funding translates to a dearth of infrastructure, deterioration of existing infrastructure due to a lack of maintenance and shortage of health workers especially in rural areas. These deficiencies in turn impact on multiple indicators, but I will be focusing on the routine immunization coverage rates which in 2011, was an unacceptable 47%, partly explaining the continued persistence of polio in Nigeria.

courtesy John Snow Inc

Nigerian mother on her way to the immunization clinic

The International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health recently released a Landscape Analysis of Routine Immunization in Nigeria. It was found that the low rates of immunization coverage in Nigeria were due to ” funding constraints, logistical challenges, and lack of leadership” or in other words, “no money to run immunization programs when needed; inability to deliver vaccines for immunization sessions and lack of cold chain equipment; and political leaders who do not prioritize routine immunization”. It is really interesting to note that the study found that lack of prioritization of routine immunization was a more important problem than actual budgeting of funds, for while the allocations are inadequate, lack of implementation further cuts the actual amount of funds disbursed. Most of the funding challenges were found at the local government level, thus even if the state and federal governments increased budgetary allocations, there would still be a bottle neck at the point of actual disbursement of the funds.

courtesy IVAC

Impact vs Feasibility of Proposed Solutions to Low RI Coverage Rates

In the light of these findings, all levels of government have major responsibilities in improving routine immunization coverage rates in Nigeria; the federal and state governments need to more seriously target the 15% budgetary allocation goal and the local government has a great role in ensuring proper and timely disbursement of such funds allocated for routine immunization. One possible approach could be the setting up of an independent committee that operates at the local government level but reports directly to the Federal Ministry of Health and that is tasked with monitoring the efficiency of utilization of funds allocated for routine immunization. This model, if successful could be applied to other sub-sectors.

It is time for the Giant of Africa to lead by example in raising routine immunization coverage rates!

References

http://www.jsi.com/JSIInternet/Features/article/display.cfm?txtGeoArea=INTL&id=329&thisSection=Features&ctid=1030&cid=248&tid=20

http://www.who.int/healthsystems/publications/abuja_report_aug_2011.pdf

http://www.jhsph.edu/research/centers-and-institutes/ivac/projects/nigeria/IVAC-Landscape-Analysis-Routine-Immunization-Nigeria-WhitePaper.pdf

http://www.vanguardngr.com/2012/11/healthcare-crisis-in-nigeria-may-worsen-in-2013-labour-warns/

http://www.jhsph.edu/research/centers-and-institutes/ivac/IVACBlog/Overcoming_Barriers_to_Routine_Immunization_in_Nigeria

http://www.globalhealthfacts.org/data/topic/map.aspx?ind=41

 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6143a5.htm#tab

 

Child Mortality in Ethiopia

March 12, 2013

In Ethiopia the “Under 5 Mortality Rate has gone down by 25.9 percent from 166/1000 deaths (2000) to 123 (2005). Currently the Governments’’ target is to reduce the …Under 5 Mortality Rate to 85 per 1000 live births.” [1]

Image

From USAID Blog

The Ethiopian Government has many hurdles to overcome. One area that they have been successful is in the reduction of the rate of child mortality under the age of 5. The Committing to Child Survival Report (2012) states that Ethiopia was one of the nine low-income countries that reduced the under 5-mortality rate by 60%.[2] I believe that this success is due to the Health Ministries’ endorsement of Integrated Management of Childhood Illnesses developed by the Government in 1997.[3] This includes training and empowering village members and caretakers to standardize and institutionalize “village” health care delivery. One of the three Priority actions supported by UNICEF is the use of Global Communication and Social Mobilization “of small-scale innovations that demon­strate strong potential for large-scale results.” Harnessing the power of mobile technology, civil society, and citizens, es­pecially women and young people, to participate in the health and wellbeing of their villages empowers individuals and communities to have a meaningful role in solving some of the worst health issues in their own country.

 

From Mom Bloggers for Social Good, Produced by UINCEF and Committing to Child Survival

From Mom Bloggers for Social Good, Produced by UINCEF and Committing to Child Survival

1. WHO 2007 Report: http://www.unicef.org/publications/files/Progress_for_Children_No_6_revised.pdf

2. UNICEF 2012 Report: http://www.unicef.org/videoaudio/PDFs/APR_Progress_Report_2012_final.pdf

3. Ethiopia Ministry of Health Web-page: http://www.moh.gov.et/English/Pages/index.aspx

Teach Your Children: Universal Childhood Education in Haiti

March 12, 2013

Haiti is a small country with big problems. With only 9.8 million citizens in the country and up to one million living in the US and Canada, it is the poorest country in the Western hemisphere and among the five poorest in the world by all measurable standards including GNP, life expectancy, literacy/education, and standards of living. Government instability and corruption and an uneven polarized social structure have severely impaired Haiti’s human development. (1) A great deal of aid, some promised and some delivered has been pumped into this small land, including moneyand resources from other countries and from many humanitarian organizations and churches. Haiti is known as the “land of NGOs” with estimated billions of US dollars in foreign aid. Still things remain quite desparate there.

Many people from countries all over the world as well as Haitians themselves have explanations and suggested solutions for Haiti’s many problems. Among the many opinions and problem solving ideas one of the most important is the Education of Haiti’s children.

Currently the state of primary and secondary education in Haiti is poor. Haiti’s literacy rate is is only 53%. The country has shortages in education supplies, physical schools and trained/qualified teachers. Moreover, demographics reveal that 70% of the population lives in rural areas but only 2020% of state education funds go to rural schools. The Ministry of Education has been deficient in its duty to improve the quality of “education for all” in Haiti. Most of the schools and teaching in Haiti are privately run and cost families too much from their meager income.

Universal education leads to “health for all”It is a basic human right and it is viewed as an “equalizer for opportunity” (2) as delineated in the 2nd MDG – universal education for all. It is well known that educated populations are generally healthier with learned knowledge about basic hygiene, nutrition, reproductive health and apprpriate health seeking activities, awareness and involvement. (3)

Bottom line: Haiti needs to take ownership in its own human development by pursuing a full committment to universal education. The benefits of an effective, sustained primary and secondary education program in Haiti would include better health, nutrition, increased productivity, reduction in gender and socioeconomic inequality and promotion of peace and stability. (4,5)

Universal free education is not rocket science. It is clear that an educated population is better off – healthier, more productive and stable. Haitians are strong and proud. They need a better way of living through education for all. A sustainable and effective education system can pull Haiti out of its overdependence on aid and into development. Elected in 2011, President Michael Martelly has made it one of his top priorities in his new government.  His cabinet has created an education fund to ensure free primary schooling for all of Haiti’s children and a program to stop the privatization of Haiti’s schools. The enormous amount of aid for education through private schools needs to be rechanneled to fund public free schooling.

It is the right thing to do. The time is now.    

1. BBC News. Haiti Country Profile 2011. http://news.bbc.co.uk/2/hi/americas/country_profiles/1202772.stm

2. United Nations:http://www.un.org/en/documents/udhr/index.shtml

3. USAID: http://www.usaid.gov/our_work/education_and_universities/higher-ed.htm

4. World Bank: http://go.worldbank.org/F5K8Y429G0

5. World Bank: http://go.worldbank.org/UTZK783TN0

Traditional Medicine in Uganda: Is it a ticking time bomb?

March 11, 2013

 

 

It is estimated that over 60% of Ugandans seek medical attention from Traditional Healers

 OLYMPUS DIGITAL CAMERA

Traditional Medicine man selling herbs. (Courtesy of disabledtravelersguide.com)

By Violet Okech, MD, MMed(Psych.); Georgina Kirunda, MSc; Remy S M Muhire, MD; Paschal Ssebbowa, MD.

It is estimated that over 60% of Ugandans seek medical attention from Traditional Healers. This pattern cuts across all social classes and educational levels.  With a medical doctor: patient ratio of 1:20,000 compared to traditional healer: patient ratio of 1:200-400, high poverty levels and a poor health system, the traditional healers’ services are the most accessible to the majority of Ugandans. With such statistics, it is inconceivable that the country has no national policy to regulate the activities of the traditional healers.  It is possible that their services may be causing more harm than good to their clients.

The World Health Organization encourages sharing of information about Traditional Medicine/ Alternative medicine policy formulation because they acknowledge the complexity of the process.  The traditional healers in Uganda have mobilized themselves under The National Council of Traditional Healers and Herbalists Associations of Uganda (NACOTHA). They seek to unite and to push for their field of Traditional Medicine to be given greater consideration by the government.  It is reported that the Ministry of Health in Uganda drafted a Policy so as to regulate and improve research in Traditional Medicine in 2008. This policy has not been finalized to date.

There is need to formulate a policy to track, regulate traditional medicine in Uganda and  conduct intensive research in traditional medicines so as to ensure proper determination and monitoring of drug safety. There is also need for preservation of the medicinal plants against extinction. Relevant medical training should also be offered to traditional healers.

 

New Antibiotics Needed to Avert Crisis

March 11, 2013

The warning about “nightmare bacteria” released recently by the Centers for Disease Control and Prevention (CDC) was not meant to be a scare tactic, but more of a call to action for doctors, hospitals, scientists, and public health professionals to address the growing problem of practically untreatable infections.  The newest concern among antibiotic-resistant bacteria is carbapenem-resistant Enterobacteriaceae or CRE for short.  It joins methicillin-resistant Staphylococcus aureus (MRSA) and multi- or extensively drug-resistant Mycobacterium tuberculosis (MDR- or XDR-TB) as bacteria that have developed mechanisms to evade the effects of many marketed antibiotics.
 
Why is action needed now?  The number of new antibiotics approved by FDA has dropped steadily while drug-resistant bacteria have continually increased over the past decade.  Without research and development focused on bringing new safe and effective antibiotics to market, these infections pose a public health crisis. 

Antibiotic Approvals 1983-2012

Declining Antibiotic Approvals 1983-2012
Image from http://www.medicalprogresstoday.com/2012/07

On July 9, 2012, the Generating Antibiotic Incentives Now (GAIN) Title of the Food and Drug Administration Safety and Innovation Act (FDASIA) was signed into law.  It is intended to stimulate innovation in antibiotic research and development while incentivizing pharmaceutical and biotech companies to continue investment in this less lucrative therapeutic area.   This is good news, but will it be enough to turn around productivity in the antibiotic pipeline?  Collaborative efforts like those of The Pew Health Group (Pew), the Infectious Diseases Society of America (IDSA), and the Pharmaceutical Research and Manufacturers of America (PhRMA) have identified areas of greatest need as well as obstacles to address.   The FDA has committed support through formation of the Antibacterial Drug Development Task Force.   It is critical that academia, professional organizations, pharmaceutical industry, and government agencies work together under this new framework to ensure effective antibiotics will be available in the future.

Bringing back sanity on Kenyan roads

March 11, 2013

Leila a wife and a mother, worked as a night guard in one of the estates in Nairobi. On this day like other she left work at 7am and started her walk home. She never saw the bus; she only heard the screech and the next thing she was lying unconscious some distance from where she was hit. There was no one present knowledgeable in first aid and no emergency line to call for assistance. The by standers only form of help was to hire a taxi and send her to the National Hospital. Leila unfortunately did not make it. This unfortunately is not a rare occurrence in Kenya.

A Kitale-bound bus at a scene of an accident that involved a 14-seater matatu and a trailer at Salgaa on the Nakuru- Eldoret highway January 1, 2013. 11 people died and two suffered injuries. SULEIMAN MBATIAH

http://www.nation.co.ke/News/11-dead-in-Kenya-road-crash/-/1056/1655292/-/13ah1y2/-/index.html

On average 35 road crashes occur each day in Kenya and approximately 7 result in death. Over 3000 Kenyans die each year due to road traffic crashes. Pedestrians and passengers are the most vulnerable and account for 80% of the deaths.

We as a country can learn from William Haddon’s conceptual framework on Injury. Stakeholders from different sectors can work together to reduce the mortality and morbidity associated with road traffic crashes in the pre-injury phase, injury phase and post-injury phase.

The transport ministry recently enacted the road traffic laws however this is not enough. Funding and strengthening of the Kenya police force to enforce these laws is paramount. Education on road safety to the public; the public service vehicle associations, passenger and pedestrians is another important piece of the puzzle to help avert injuries in the pre-injury phase..

In the injury  phase; for example in the case of Leila the bus losing control, we can prevent injury by making changes in the environment. The Ministry of public works needs to install crash barriers between the road and pedestrian walk to prevent cars from hitting pedestrian.

We can minimize the effect of the injury on the victim by ensuring that emergency medical services, trauma care and rehabilitation are provided promptly by investing in ambulances and paramedics.

The battle to bring back sanity on Kenyan roads can only be won if all involved stakeholders; the government, the citizens, advocacy groups and Public service vehicle associations work together.

Other references:

Injury prevention

Severe road traffic injuries in Kenya, quality of care and access

Matatu owners oppose new traffic law

Access to Isoniazid Preventive Therapy in Tanzania

March 11, 2013

According to the World Health Organization, a third of the global population is infected with TB; TB is the second biggest infectious disease killer in the world; and TB is responsible for more deaths in HIV+ persons than any other cause.

While we have long known how to prevent, diagnose, and treat TB, far too many people continue to be infected and die from TB, especially in the HIV+ population concentrated in sub-Saharan Africa.  In more pressing terms, a 2010 article published in AIDS stated:

“In most HIV prevalent countries, HIV is the predominant driver of the TB epidemic.  Decades of progress in TB control have been reversed or slowed by failure to identity, prevent, and treat TB in HIV-infected persons, their families, and their communities.”

Key stakeholders including the WHO, the StopTB Partnership, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria all recognize Isoniazid Preventive Therapy  (IPT) as a key part of global TB control.  Isoniazid, a cheap antimicrobial, can be given to HIV+ persons to prevent the progression from the mostly innocuous latent version of TB to the active, deadly form of the disease.  However, it is still not being widely used in the places it is most needed, including Tanzania.  The following WHO graphic shows that Tanzania isn’t even recording any IPT administration to the people who most need it.

Screen Shot 2013-03-10 at 11.32.25 PM

 

 

Screen Shot 2013-03-10 at 11.32.07 PM

 

 

Why not?  The problem  is of course complex.  Buy-in is needed from the Ministry of Health in Tanzania; not even collecting an important indicator demonstrates a lack of commitment.  Further, the Tanzanian HIV/TB protocol has not been updated to WHO standards related to IPT. Without the MOH’s input, it will be difficult for key providers (physicians, nurses, pharmacists, and community health workers) to have the necessary protocols, training, and drug access.  Additionally, without a clear policy on IPT in HIV+ persons, isoniazid often remains a tightly controlled drug (for example, only available at a regional TB hospital instead of available at all health centers treating HIV+ persons).

Drug stock-outs also contribute to the under-utilization and under-completion of IPT in Tanzania; while isoniazid is procured through The Global Drug Facility, poor record keeping at regional and district levels often means that it is not distributed to where it needs to go.  Further, INH might be administered by a public facility, private facility, NGO, or pharmacist—more standardization is needed to streamline the process of IPT.

While there are additional factors contributing to inadequate provision and maintenance of IPT in HIV+ persons in Tanzania, these highlighted components are prime areas for Tanzania, with the support of international donors and technical advisers such as the WHO and the Global Fund, to focus on as they update TB/HIV protocols, obtain additional funding, and expand training for health care providers in their country.