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Building Community Capacity to Fight Pneumonia and Save Children’s Lives

This blog post was written by Amy Sarah Ginsburg, MD, MPH, Senior Advisor in International Programs at Save the Children U.S.A, and Kurabachew Abera, MD, MPH, Health and Nutrition Team Leader for Save the Children Ethiopia. Save the Children believes every child deserves a future. In the United States and around the world, they give children a healthy start in life, the opportunity to learn and protection from harm. Save the Children is a Global Health Council 2017 member.

 

“We are living in the midst of a pneumonia pandemic. No disease kills more children.”
 – Kofi Annan, former United Nations Secretary-General

As we mark World Pneumonia Day this month, we reflect on our progress in the fight against pneumonia as well as the work ahead. A Save the Children report, Fighting for Breath, shows child mortality rates are at an historic low, however even this “good news” means 5.6 million children died in 2016 before their 5th birthday.

Why are millions of children still unable to access life-saving nutrition, vaccines, and medicines? How can we ensure all families have access to the health care they need to protect their children from pneumonia and other illnesses? The answer is simple: we need to reach the unreached. The reality, however, is one of the most daunting global health challenges we have yet to face.

Today’s global health landscape has greater complexity than we encountered in past decades. We have made remarkable progress by addressing a then-universal challenge of developing countries – the lack of access to basic health care interventions such as antiretrovirals, vaccines, and contraception. Aggressive strategies, developed by global institutions and skillfully implemented by countries, began to close – though not eliminate – the access gap between industrialized and impoverished countries. This global approach, coupled with significant economic gains in many African and Asian countries, yielded dramatic results. By employing a largely “one size fits all” approach, we succeeded in saving millions of lives.

The success of this approach has fundamentally changed the challenges ahead. As is widely acknowledged, the communities untouched by global advancements are often the poorest of the poor, war-torn, geographically remote, mobile/pastoralist and/or historically underserved. Inequities in communities’ abilities to access basic health care are not only between rich and poor countries, there are often significant disparities within countries. Our continued progress is dependent on our ability to understand, navigate and influence these diverse communities.

Ethiopia’s experience illustrates this point. Nationally, the country has demonstrated remarkable progress in expanding access to health care, reducing hunger and undernutrition, and improving its economy. Since 1990, Ethiopia has reduced its child mortality rate by more than 75% from 203 to 58 per 1,000 livebirths. The success is largely due to increased use of tools and approaches made possible by the health extension program, a home-grown innovative community health program that increased access to basic health care.

Though Ethiopia has made significant headway, analysis shows this progress is uneven. The more remote areas of the country, such as the developing regional states of Somali and Afar, have made relatively few health gains. Many of these communities have weak linkages to the overall health system, which is inadequately resourced and often inaccessible. Cultural factors inhibit appropriate health practices, and there are few sources of accurate health information. Not surprisingly, there is poor uptake of the life-saving reproductive, maternal and child health interventions that are responsible for the dramatic health gains in other regions. As a result, the child mortality rate in these regions remains stubbornly high at nearly twice the national average.

In Afar and Somali, as in so many other communities around the world, cultural, geographic, political and economic forces converge at the community level and serve as complex barriers to improved health. Unfortunately, there is no “one size fits all” strategy to reach the unreached. We need careful analysis of local facilitators and barriers and community engagement to determine the best way forward.

Save the Children is developing country advocacy initiatives to strengthen the capacity of countries to address their complex health challenges. In Ethiopia, we are working in Afar and Somali regions to identify significant health system gaps, and engaging communities and policymakers to develop ways to close them. Our current work in Ethiopia focuses on maternal, newborn and child health including prevention and treatment of childhood pneumonia, the leading infectious cause of death for children. Save the Children is working with the Ministry of Health of Ethiopia to ensure universal access to quality neonatal and child health services. To this end, improving quality and scaling up integrated community case management and community-based newborn care as part of the package of the health extension program in Afar and Somali regions are priorities. Coupling community-based advocacy with efforts to improve child health, allows us to drive change by promoting health interventions -including immunization, nutrition, and access to care- that can reverse persistently high rates of child mortality.

Our work in Ethiopia recognizes that countries are both innovators and implementers – to shape and sustain change we need to strengthen the work of in-country stakeholders, leaders and partners. We must find new ways to provide catalytic investments, build government and community capacity, and to foster evidence-based and systems innovations that can save lives. This means listening to, empowering and holding accountable, governments and stakeholders closest to the most difficult problems.

Our global vision of achieving the ambitious Sustainable Development Goals requires us to find new ways to improve the health of families in the poorest and most remote regions of the world. As we evaluate the global health community’s annual progress and consider priorities for the year ahead, high among them should be increased support for country advocacy. This is complex, incremental and important work. It is the path we must travel to meet our global goals and save children’s lives.

 

ASTMH Kicks Off 2017 Annual Meeting by Premiering Its First Society-Level Medal Named After A Female Icon In Tropical Medicine

This blog post was written by Doug Dusik, Senior Communications Executive, American Society of Tropical Medicine and Hygiene (ASTMH)The American Society of Tropical Medicine and Hygiene, founded in 1903, is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health. The organization accomplishes this through generating and sharing scientific evidence, informing health policies and practices, fostering career development, recognizing excellence, and advocating for investment in tropical medicine/global health research. ASTMH is a 2017 Global Health Council member.

The American Society of Tropical Medicine and Hygiene (ASTMH) kicked off its 66th Annual Meeting in Baltimore on Sunday by presenting a new honor and first for the Society: the Clara Southmayd Ludlow Medal, the first named after a female icon in tropical medicine. The ASTMH Council recognized the absence of a Society-level medal named after a woman as an oversight and announced its plans at the 2016 Annual Meeting, soliciting nominations earlier this year. The new medal recognizes honorees of either gender for their inspirational and pioneering spirit, whose work represents success despite obstacles and advances in tropical medicine. The medal was named for Clara Ludlow (1852-1924), the Society’s first female member and its first non-MD member, an entomologist with scientific zeal and tenacity who battled the odds of age, gender and skepticism of women in the sciences to advance the understanding of tropical medicine.

• Front of ASTMH’s new Clara Southmayd Ludlow Medal, its first named after a female tropical medicine icon.

The medal’s first recipient selected is Ruth S. Nussenzweig, MD, PhD, of New York University of Medicine, whose extraordinary contributions forever changed malaria vaccine research at time when it was thought that a malaria vaccine was impossible. Her work, with husband and collaborator Victor Nussenzweig, showed otherwise, paving the way for today’s malaria vaccine efforts. Dr. Nussenzweig was unable to attend the awards ceremony but her son, Andre, accepted the medal on his mother’s behalf. Also in attendance were Dr. Nussenzweig’s grandsons, Julian and Samuel.

• Back of the Ludlow Medal bearing the name of its first recipient, Ruth S. Nussenzweig.

The Society was equally delighted to have two family members of Clara Ludlow: Elizabeth Thomas and Sarah Brown Blake. Elizabeth Thomas is a second-year doctoral student in the Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health in Baltimore, and Sarah Blake Brown is a Postdoctoral Scholar at the Betty Irene Moore School of Nursing at the University of California, Davis. Her professional nursing experience is rooted in community and public health with a focus on Maternal Child & Adolescent Health. Clearly, the spirit of Clara Ludlow is in their DNA.

Elizabeth and Sarah bestowed the Ludlow Medal on Andre Nussenzweig. ASTMH President and awards ceremony moderator Patricia F. Walker, MD, DTM&H, FASTMH, described it as a way of history connecting to the past.

The ASTMH Annual Meeting continues through Thursday, when National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, will deliver a special plenary session. Other highlights included a keynote address by Paul Farmer, MD, PhD, Co-founder and Chief Strategist of Partners In Health (PIH) and a chance for attendees to give back to the global health community by receiving their annual flu shot via Walgreens’ Get a Shot. Give a Shot.® campaign through the United Nations Foundation’s Shot@Life campaign.

 

Where is HER voice in the Global Fund’s next Executive Director?

This post originally appeared on the Women in Global Health website. This guest post was written by Kelly Thompson, Ann Keeling, Roopa Dhatt, and Caity Jackson from Women in Global Health. Established in 2015, Women in Global Health (WGH) was founded with the values of being a movement. WGH works with other global health organizations to encourage stakeholders from governments, civil society, foundations, academia and professional associations and the private sector to achieve gender equality in global health leadership in their space of influence. 

**Update: The original version of this blog featured data points from 2008 and early 2017. The graphic has been updated to reflect the most recent data from the GFATM Secretariat.

Infographic Courtesy: Women in Global Health

Last Tuesday, without much fanfare, The Global Fund to Fight, AIDS, Tuberculosis and Malaria (GFATM) unceremoniously announced the 4 short-listed candidates for its next Executive Director (ED). In contrast to the World Health Organization’s (WHO) recent attempts at developing a more transparent and open process for the selection of their Director General, the GFATM process has been shrouded in secrecy. The first attempt to select its ED, set to replace Dr. Mark Dybul, who stepped down in May, was abruptly aborted. With rumors swirling and one of the candidates, Helen Clark, suddenly removing her candidacy, the GFATM Board noted that due to problems encountered in the recruitment process they were going to draw that round to a conclusion and restart the process (1). In this new round, 3 men and 1 woman have been shortlisted, also harkening back to the WHO election where gender parity was not reached in the final candidates. There is also a startling lack of geographical diversity in the final candidates with two from the United Kingdom, and one each from the USA and Tanzania.  

In one way, we should not be surprised that the shortlist is dominated by men, every previous ED has been a man, with the exception of Dr. Marijke Wijnroks, who is currently serving as the Interim ED. But since women are the majority of the workforce in the sectors of health the GFATM covers it is surprising that the shortlist is not 3 women and 1 man or at least 50/50 women and men. In the lead up to the second round the names of some outstanding women leaders in global health were circulating as being in the race. Talented women are out there and we should be surprised that the final shortlist is not gender balanced. It goes without saying that whoever is selected, regardless of gender, needs to have a strong understanding of the interplay of gender within the three diseases and how to apply a gender transformative approach to their leadership.

The GFATM’s own 2017 report notes the variety of ways in which the three diseases are gendered (2). Some of the key examples include, in some parts of Africa, young women (15-24 years old) are eight times more likely than young men to be living with HIV, and in the hardest hit countries 80% of new HIV infections are among adolescent girls. Those same adolescent girls are also more likely to be impacted by tuberculosis. Whilst malaria greatly affects pregnant women and children under 5, in some areas, like the Mekong, malaria greatly impacts men, who make up the migrant and mobile population. GFATM has adjusted its funding and programming to reflect these gender needs, with 60% of current investments being targeted at women and girls, and the announcement of the HER Voice fund to be launched in November 2017. However, as noted by Hawkes, et al there are still major gaps in transforming this policy into reality and often ‘too few grant agreements are found to specify, fund or monitor gender-sensitive or transformative activities’ (3).

We urge the Board to prioritise these considerations in the ED’s selection:

1) Strong development background and connection with the reality of the context of the GFATM’s work.
2) Strong commitment to gender equality essential to delivering GFATM’s work and Universal Health Coverage (UHC).
3) Commitment to reform of the GFATM including promoting diverse leadership.
4) Commitment to partnerships and building/engaging civil society particularly from the global south.


In closing, we ask all ED candidates, how will you address gender equality in the Global Fund?  


(1) Zarocostas, John. Controversy embroils selection of new Global Fund head The Lancet , Volume 389 , Issue 10072 , e3.

(2) Results Report 2017. The Global Fund. https://www.theglobalfund.org/media/6773/corporate_2017resultsreport_report_en.pdf

(3) Hawkes, Sarah. Gender blind? An analysis of global public-private partnerships for health. Globalization and Health 201713:26

The Fight to Make Nigeria Once Again Polio-Free

This blog post was written by Chizoba Unaeze, Program Manager, International Medical Corps Nigeria. International Medical Corps (IMC) is a global, nonprofit, humanitarian aid organization dedicated to saving lives and relieving suffering by providing emergency relief, health care training and development programs to those in great need. IMC is a Global Health Council 2017 member.

A seven-day-old baby receives an oral polio vaccine in the Maiduguri neighborhood of Hausari. International Medical Corps, as part of a wider effort to eradicate polio from Nigeria, often targets baby naming ceremonies, which take place a week into a child’s life, to vaccinate the newborn as well as other children attending the ceremony. Picture courtesy: International Medical Corps.

In August 2016, four children under five years old were reported paralyzed from wild poliovirus in Nigeria’s conflict-ridden Borno State. The resurgence of the disease came after more than two years without any cases of the poliovirus—a consequence of the seven-year Boko Haram insurgency, which has fueled instability and displacement and left thousands out of reach of humanitarian assistance.

Despite the security risks, International Medical Corps, together with local and international partners in the CORE Group Polio Project (CGPP), is making sure children are vaccinated against polio, despite the wide-reaching damage the conflict has had on the health system. Each immunization Plus Days campaign month, International Medical Corps and its local partners (AHIFF in Borno and CSADI in Kano) through social mobilization and house to house visits with the state vaccination teams in the focal areas vaccinate more than 180,000 children in Borno State and 85,000 in Kano State against polio—according to call in data as collated and analyzed by the Emergency Operations Centres in the states.

Such high vaccination numbers don’t just happen.

They are the result of careful planning, organization and coordination—all skills that require a variety of training curricula. For example, we train supervisors how to use smart phones for tracking project activities at neighborhood and community levels, how to use registers filled out by Volunteer Community Mobilizers—known as VCMs—to assure no households are missed. The VCMs are also taught how to find and engage pregnant women and new mothers, how to encourage them to bring their children to immunization sites for vaccinations, and how to find and report young children suffering from paralysis—and possible polio.

As part of the CGPP Consortium, International Medical Corps trainers also mentored and supported local government staff and volunteers on ways to address community suspicions about the vaccination campaigns—suspicions that can generate outright resistance to immunization.

One such example occurred when community residents in a sub-unit of one district—called a “Ward”—resisted vaccination of their children against polio. For two subsequent rounds of monthly campaigns residents did not allow any of its children to be immunized, significantly increasing the likelihood of children contracting polio.

In response, the local government formed a team with individuals from UNICEF, Rotary Club, and International Medical Corps, along with the local government health officer that met with community health officials, local council members as well as influential traditional, religious, and other community leaders to engage in a dialogue to address the causes for resistance and ease concerns.

As this meeting progressed, it became clear the residents resented the importance outside authorities were giving to the polio campaign when other long-ignored community needs remain neglected. One resident pointed out the community lacked basic services, including proper health care, clean water and prevention against other diseases such as malaria and cholera that killed the children. Others noted that medicines were either not available or too expensive for them to purchase. They wanted to know why there were so many rounds of polio vaccinations taking place in their area; why their basic health care needs remained unaddressed while outside authorities focused solely on polio.

It was quickly clear from the government-led team that the concerns expressed by residents were genuine and had to be dealt with honestly. The team initiated a dialogue under the leadership of a local traditional leader, called a Bulama, to resolve the complaints.

Once community residents could see their complaints were being addressed, the resistance ended. With a plan of action agreed, a house-to-house polio immunization campaign followed that reached every single child in that community.

It has been more than a year since a case of polio was detected in Nigeria. I believe that if we keep engaging in dialogue, with explanations and persuasions on both sides, and getting vaccines out to communities, we will once again rid Nigeria of polio—one household at a time, immunizing one child at a time.

Advocacy Update ~ October 23, 2017

This post was written by Danielle Heiberg, Senior Advocacy Manager, and Melissa Chacko, Policy Associate, Global Health Council.

Senate Passes Budget Resolution

Late last week the Senate passed a Budget Resolution, setting topline funding amounts for the appropriations bills for Fiscal Year (FY) 2018, but similar to the House, the chamber really set up the vehicle for tax reform. The bill maintains spending at 2017 levels, but over the next ten years would cut nondefense spending, ending in 2027 with a $106 billion cut. For the International Affairs Budget, the bill contains $39.5 billion in base funding (the funding breakdown for Overseas Contingency Operations (OCO) between defense and international affairs was not specified).

Although the vote was along party lines (with all Democrats and Independents, along with Senator Rand Paul (R-KY), voting no), some Republicans downplayed its importance. Senator John McCain (R-AZ) stated, “At the end of the day, we all know that the Senate budget resolution will not impact final appropriations.”

Congress has until December 8, when the Continuing Resolution (CR) expires, to work out a final spending bill for the eight remaining appropriations bills for the fiscal year.

Reach Act Introduced in the U.S. House of Representatives

In early October amidst the hustle and bustle of the budget resolution debates, U.S. Representatives David Reichert (R-WA), Betty McCollum (D-MN), Barbara Lee (D-CA), and Daniel Donovan (R-NY) reintroduced the Reach Every Mother and Child Act (H.R. 4022) in the House of Representatives. This bipartisan legislation aims to accelerate the reduction of preventable child, newborn, and maternal deaths, putting us within reach of the global commitment to end these deaths within a generation. The Senate reintroduced the Reach Act in August, which now has 14 cosponsors. Read GHC’s statement.