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US Delegation Visits AIHA Biomed Project in Uganda

This guest post was written by GHC Member, American International Health Alliance (AIHA)

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AIHA’s PEPFAR-supported partnership is building Uganda’s capacity to train and support biomedical engineers and technicians as a way to improve health services.

In the global fight against HIV/AIDS, physicians, nurses, and community health workers are on the front lines of the response. No less important, however, are the many health workers who toil behind the scenes every day to help ensure the quality of clinical care provided to people living with HIV.

Biomedical engineers and technicians (biomeds) are one of those oft forgotten cadres. They play a crucial role in the day-to-day operations of hospitals and other clinical sites by ensuring that laboratory equipment and medical devices are in optimal working order. Their efforts underpin accurate and efficient diagnosis, treatment, and management of HIV, as well as other acute and chronic conditions.

A high-level delegation from the US Department of Health and Human Services (HSS) and the US Centers for Disease Control and Prevention (CDC) got a first-hand look at the contributions biomeds make to the care and treatment of people living with HIV during a visit to health facilities in the Eastern Uganda town of Jinja, some 40 miles from the capital of Kampala.

There, the US officials learned about the impact that a capacity building project being implemented by AIHA through our HIV/AIDS Twinning Center Program is having on the local health system.

“The successes seen in Jinja are one example of a national-level program experiencing a similar ripple effect regionally across the country,” explains AIHA Program Manager Silas Goldfrank.

“Starting with non-automated laboratory equipment, AIHA is taking a step-wise approach to build the capacity of biomeds to become specialized in conducting preventive maintenance, repair, and calibration of laboratory equipment critical to the HIV clinical cascade,” Goldfrank says, noting that the end goal is training them to maintain the highly automated equipment required for viral load testing in support of the UNAIDS 90-90-90 targets.

As the US President’s Plan for AIDS Relief (PEPFAR) and national ministries of health shift focus to receiving SLMTA and/or ISO accreditation for their labs, having in-house biomeds with the skills necessary to work alongside laboratory technicians and conduct routine preventive maintenance and repair is essential to that process.

Through our Twinning Center Program, which is supported by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), AIHA has adopted a multi-pillar approach to ensure the work being has lasting, sustainable impact in Uganda.

Though our direct partners are the Ugandan Ministry of Health’s Infrastructure Division (HID) and Central Public Health Laboratories (CPHL), AIHA is also collaborating with educational institutions and regulatory bodies to ensure what is being implemented builds on existing programs and will eventually become the national standard for laboratory equipment management and maintenance.

Some highlights of the site visit included the hospital blood bank, automated laboratory, new biomed workshop, mortuary, and operating theater, where the equipment is similar to what is required for large-scale freezers used in laboratory cold chain systems and labs when they shift to high tech VL machines, for example.

AIHA has similar in-service biomed programs in Kenya and Zambia, as well as a combined pre-service and in-service biomed program in Ethiopia, where we are seeing similar impact on the ground. In the coming year, we will be launching a new biomed project in Tanzania and hope our work in this technical area will be able expand in future funding cycles.

From AIHA’s perspective, it’s great to see PEPFAR supporting the need to continue building the capacity of this cadre and expanding from one project that launched in 2012 in Ethiopia to now to a total of five countries across sub-Saharan Africa.

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Raising Public Awareness Around Violence against Women

By Lanice Williams, Policy Associate, GHC

“There is one universal truth, applicable to all countries, cultures and communities: violence against women is never acceptable, never excusable, and never tolerable,” UN Secretary-General Ban Kai-Moon

On Friday, the world will observe the International Day for the Elimination of Violence against Women. This day not only recognizes violence against women as a substantial global health and human rights issue, but provides a platform for governments, international organizations, and NGOs to organize activities designed to raise public awareness about the problem. It is also an opportunity for individuals to come together, assess what strides have been, and develop solutions to end all forms of violence against women.

It is estimated that approximately 35% of women have experienced physical or sexual intimate partner violence or sexual violence by a non-partner at some point in their lives. This high occurrence of violence and how it severely impacts women and girls makes it one of the most critical issues to be addressed in our time. Ending all forms of violence against women is a critical target towards achieving Sustainable Development Goal 5 (SDG) – gender equity and empowerment of all women and girls. A  UN Women report, “A Framework to Underpin Action to Prevent Violence against Women,” breaks down the complicated relationship that still exists between gender and violence. The report highlights violence against women as one of the most pervasive human rights violations in the world, rooted in gender inequality, discrimination, and harmful cultural and social norms.

Although violence against women and girls is not a new phenomenon, the response to acts of violence continues to be focused on intervening after the situation has occurred. A more effective response would be shifting our focus to solutions that prevent violence from reoccurring or occurring in the first place. The initial steps we need to take in order to do this include: understanding the root causes of violence, addressing gender roles and the way in which society views women and men, improving access to health services, investing enough resources to combat violence, and working closely with men and boys to change gender inequitable attitudes and norms. Without addressing these, women will continue to bear the burden of the long-term mental health effects of violence and will be more susceptible to HIV/AIDS, all of which in turn affects their children, families, and the larger community.

As part of their work on health, gender, and violence prevention, many organizations have developed programs to address the social norms, behaviors, and attitudes around violence and improving the health services available for survivors and their families. For example, Partners for Prevention works with men and boys in seven Asian and Pacific countries to address social norms, promote non-violence, and change gender perceptions and stereotypes. This approach continues to show that men and boys play a critical role in changing the male-centric views on violence against women.

In addition to changing men’s perceptions on violence, improving access to services such as psychosocial counseling and healthcare is critical in reducing the negative effects associated with violence. Recently, Together for Girls launched the Every Hour Matters campaign, which focuses on increased awareness of the importance of rapid access to care within 72 hours after a woman or girl has experienced sexual violence and ensuring that these services are available in communities in low- and middle-income countries. Within the first 72 hours of experiencing sexual violence, it is critical for a woman to have access to emergency contraception and post-exposure prophylaxis (PEP) – two interventions that lower the risk of an unwanted pregnancy and contracting HIV. However, in areas where women suffer a higher likelihood of experiencing sexual violence such as in areas of conflict, these services are not widely available.

Programs such as these must be adequately funded and integrated throughout communities and schools in order to see a decline in incidents of violence. These programs not only address the unique challenges that women and girls face worldwide, but are an important part of how we will achieve SDG 5 and the broader sustainable development agenda. From November 25 through December 10 –  Human Rights DayUNITE to End Violence against Women will host the 16 Days of Activism against Gender-based Violence campaign. This year’s campaign, “Orange the World: Raise Money to End Violence against Women and Girls,” focuses on the need for sustainable financing to end violence against women around the world.

As a community we must act now to end the shortfall in providing adequate services that are available to survivors of violence and the lack of focus on prevention, and ensure that the health and well-being of all women and girls worldwide are no longer stunted by violence.

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Oh crap, challenges to universal sanitation by 2030

By Bonnie Leko-Shapiro, Consultant, Global Health Council 

World Toilet Day is tomorrow November 19. In the intersection of water, sanitation, and hygiene (WASH) and global health, this is a significant opportunity to highlight the critical need for better sanitation around the world. A new report, Overflowing Cities, The State of the World’s Toilets 2016, from WaterAid America, delves deeply into this complex issue.

Access to basic sanitation was incorporated into the Millennium Development Goals (MDGs), but was not achieved before the sunset of the MDGs. It is one of the stark failures of the MDG agenda. With the adoption of the Sustainable Development Goals, one goal (Goal 6) specifically calls for the need to “ensure the availability and sustainable management of water and sanitation for all.” There is now recognition that sanitation is an integral part of human development and target 6.2 specifies achieving “adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations” by 2030.

The challenges in failing to meet the sanitation target in the MDG era will continue to pose challenges for universal sanitation moving forward in the SDGs. First, people are moving from rural areas to urban areas very rapidly. In fact, in many places, city populations are growing much faster than sanitation improvements. This results in increasingly densely populated areas, and often in informal settlements, which leads to the second major challenge: infrastructure.

Improving sanitation is an inherently costly proposition; and to do it properly, financial and political commitments must be complemented with community buy-in. The rush to urban areas creates or exacerbates open sewage systems, if any sewage system exists at all. Pit latrines may be progress in rural areas where no other safe sewage option exists, but they are insufficient and dangerous in crowded areas.

Exposed feces, including those flowing through settlements in open trenches or rivers, cause illnesses and diarrhea, which kill hundreds of thousands of people annually. The health threat of open defecation and stagnant sewage is widely understood, however there are also cultural challenges to improving sanitation:

1. Sanitation is not glamourous. It is not exciting for officials or the average person to talk about. Understanding the requirements of a well-built, effective, and properly maintained sewage system is highly technical and many people find the subject matter unpleasant.
2. Context matters. Sanitation projects require support from governments on all levels –national down to the municipal levels. There are also many locations where land rights are legal obstacles to developing and implementing sanitation projects. Navigating these murky waters is costly in both time and money.
3. Not priority infrastructure (unlike roads or telecoms). As one of 169 targets specified in the SDG agenda, sanitation is clearly completing against dozens of other priorities. Civil society, the private sector, and government must all work together to plan, fund, and maintain sanitation systems.
4. Social taboos. Discussing menstruation, defecation, and urination ranges from distasteful to prohibited in several cultures. As target 6.2 specifically mentions, women and girls require consideration, something that is not automatically assumed in some places.

Ultimately, improvements can only be made by addressing systemic challenges in political, cultural, and financial approaches to development. There is no silver bullet to fix the complex barriers to universal access to quality sanitation. However, there are a couple of case studies of successful sanitation development projects. Nongovernmental organizations (NGOs) can serve a key function in bringing disparate groups to the table and facilitate connections among the communities to be served; between the communities and their governments; and between the communities, governments, and private sector. Public-private partnerships have great potential to invigorate this area.

An attitudinal shift that adequate housing, a commonly agreed on metric of development, must include good sanitation is also necessary. The focus of World Toilet Day 2017 is Toilets & Jobs. Building sufficient sewer and treatment infrastructure is not enough. To be sustainable, people must be trained to maintain the infrastructure and products, creating opportunities for micro and small businesses to develop. Loans and subsidies from government and the private sector have been moderately successful in some places to help jump-start a sanitation market.

Creative solutions are required to get investment in sanitation as returns do not tend to be obvious or immediate. Rather, they are usually secondary through improved school attendance, better community health, increased productivity by workers, etc.

WASH and global health are intricately linked. There are only 14 years to achieve the SDGs, so we need to all give a crap about urban sanitation improvements.

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Advocacy for Community Treatment Toolkit

This revised, updated and expanded advocacy toolkit from International Treatment Preparedness Coalition is designed to support communities to demand optimal HIV treatment. Topics covered in the Toolkit include: the science of HIV, the relationship between human rights and HIV treatment, and financing for health. It also highlights opportunities and barriers to scaling up treatment, as well as provides practical guidance on how to mobilize communities to increase access to treatment. Access the toolkit.

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Kenya Leads World’s First Nation-wide Introduction of New Child-Friendly TB Medicines

This post was provided by GHC member, TB Alliance

New drugs designed to treat pediatric TB are expected to improve child survival

tba-kenya-3075On October 1, 2016, Kenya launched simpler and more affordable fixed dose combinations for drugs to treat tuberculosis (TB) in children. This was the first national roll out of these improved medicines. Working in close collaboration with Kenya’s Ministry of Health, UNITAID, and other partners, these medicines make it easy for caregivers to accurately and efficiently provide treatment for children suffering from TB. The advanced medicines are expected to make TB easier to treat, improving the daily lives of children and their families.

“Kenya is playing a leading role in the fight against childhood TB by being the first to introduce improved TB medicines for children,” explained Kenya’s Cabinet Secretary for Health Dr. Cleopa Mailu. “Now, with the appropriate treatments, we can make rapid progress in finding and treating children with TB so we can achieve a TB free generation.”

New data indicates that TB is a greater threat to children’s health than previously thought. According to the newly released World Health Organization (WHO) report on global TB, there was a 50 percent increase in reported deaths of children from TB, with 210,000 dying of the disease in 2015 alone. That means 575 children die each and every day from a preventable and curable disease. Infants and young children are especially at risk of having severe, often fatal forms of TB including TB meningitis, which can leave them blind, deaf, paralyzed, or mentally disabled. In 2015, Kenya reported nearly 7,000 cases of TB in infants and children, with those under age five at greatest risk of having a severe form of TB.

Previously, parents and caregivers had to hand crush and break multiple, bitter-tasting pills to achieve the right doses for children. Often these attempts did not yield accurate doses and, even when they did, the child was not likely to swallow or keep down the medicine. This difficult six-month journey through treatment contributed to low adherence rates.

The newly introduced, quality-assured medicines, are not new treatments but rather improved formulations that are easy for providers and parents to give, and easy for children to take. The tablets are fruit-flavored and are fixed dose combinations that contain the proper dosing ratio of the necessary TB drugs. They can quickly dissolve in water.

“No child should die of TB, yet for too long, we have not had the medicines to mount a sustainable response against childhood TB,” said Mr. Robert Matiru, Director of Operations for UNITAID. “UNITAID’s investment in addressing this problem should help equip countries, health care workers, and families with the tools they need to rise to the challenge.”

Other countries are following Kenya’s lead and are now planning for rollouts, exceeding initial launch expectations. The uptake of the new FDCs is progressing very quickly—it is estimated that more than 230,000 treatment courses have been ordered by almost 30 countries as of November 2016. These orders could cover more than 50% of all children reported with TB.

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