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Using a Human-Centered Design Approach for Future NCD Policies

This post was written by Melissa Chacko, Policy Associate, Global Health Council.

Poster for UNGA side-event “Health, Global Goals, and Non-communicable Diseases: A Healthy, Safe Environment for Children and Youth.”

It is acknowledged that the key to successful community health interventions is creating community ownership and providing the necessary resources to design community-driven evidence-based sustainable solutions. This methodology is often referred to as human-centered design which is innovation that requires engaging people in order to understand their preferences. By including the “users” from the beginning, this ensures that participation after implementation of the program will be sustainable. While there are numerous examples of human-centered public health interventions, this approach is limited in policy-making. A possible area in global health that could benefit from a human-centered design policy approach are programs that target noncommunicable diseases (NCDs) and which place a large focus on analyzing human behavior to create preventive services within high-risk populations.

As seen in grassroots campaigns, the level of urgency and accountability to create robust health policies elevates when patient advocates and community health workers are involved in policy-making. With this in mind, those working to address NCDs might benefit from a human-centered design policy approach by including patients and community health workers in the policy-making process. The need for an increase in patient advocates in policy was highlighted at a panel, “Health, Global Goals, and Non-communicable Diseases: A Healthy, Safe Environment for Children and Youth,” held on the margins of the 2017 UN General Assembly (UNGA). The side event was sponsored by Global Health Council members and partners including NCD Child, NCD Alliance, International Pediatric Association, and American Academy of Pediatrics. Panelist Cajsa Lindberg, President of UNG Diabetes, stated, “The power of patient advocates is that they are the experts on what they want, what they need, and what needs to be changed. Data alone cannot cause change.” Patient advocates and community health workers involved with NCD advocacy are stakeholders in the policy process and therefore as “users” they need to be at the forefront of policy-making.

Panelist Cajsa Lindberg, President of UNG Diabetes, speaks at UNGA side-event, “Health, Global Goals, and Non-communicable Diseases: A Healthy, Safe Environment for Children and Youth,” in New York.

However, in order to prevent an echo chamber of thoughts and ideas among NCD programs and NCD advocates, it is essential that non-traditional health stakeholders are involved in the human-centered design policy process. This is crucial as NCD programs address the social determinants of health and the economic complexities of countries such as agriculture and trade. Including non-NGOs such as the private sector and non-health government departments like the agriculture department, could galvanize a new group of advocates outside of the health sector. Embedding multi-sector stakeholders at the beginning of the policy making process could also increase both the visibility and dialogue of NCD issues outside of the global health community. Moreover, synergizing the expertise of NCD patients and community health advocates with the leveraging power of non-traditional health stakeholders could increase pressure on legislators to move NCD policies forward and ensuring the sustainability of policies that address NCDs.

This is a visionary outlook of what the NCD programs human-centered policy approach can be. Bridging NCD programs and advocates with non-traditional stakeholders will first require highlighting the expertise and narratives of NCD patients and community health workers to address the need for a human-centered design approach. This will raise awareness and educate non-NGOs and legislators about the complexities of NCD prevention and treatment.

The NCD Roundtable is currently in the process of collecting these narratives to push these advocacy efforts. The Roundtable welcomes submissions, please email (advocacy@globalhealth.org), for guidelines and instructions to submit.

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U.S. HOUSE OF REPRESNTATIVES INTRODUCES LEGISLATION AIMED TO SAVE LIVES OF WOMEN AND CHILDREN AROUND THE WORLD

Washington, DC (October 13, 2017) – On October 10, Global Health Council (GHC) applauded U.S. Representatives David Reichert (R-WA), Betty McCollum (D-MN),Barbara Lee (D-CA), and Daniel Donovan (R-NY), who reintroduced the Reach Every Mother and Child Act (H.R. 4022) in the U.S. 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.

“We are in reach of ending preventable maternal and child deaths—a great accomplishment in part due to U.S. leadership and investments in maternal and child health programs. Although we have drastically reduced the number of maternal, newborn, and child deaths, every day, 800 women die from complications of pregnancy and childbirth and more than 16,000 children still die from preventable causes,” said Loyce Pace, GHC President and Executive Director. “The Reach Every Mother and Child Act is an important step to ensure that we end these preventable deaths within a generation.”

The Reach Act builds upon the success of such global health initiatives as PEPFAR and the President’s Malaria Initiative (PMI), and would enact key reforms that increase the effectiveness and impact of USAID maternal and child survival programs. The U.S. Senate reintroduced the Reach Act in August.

Specifically, the legislation would require a coordinated U.S. government strategy that addresses ending preventable child and maternal deaths, as well as institute reporting requirements to improve efficiency, transparency, accountability, and oversight of maternal and child health programs. In addition, it would establish the position of Child and Maternal Survival Coordinator at USAID and ensure that the return on U.S. investments are maximized through a scale-up of the highest impact, evident-based interventions. The legislation would also allow USAID to explore innovative financing tools.

The Reach Act is supported by more than 50 diverse non-profit and faith-based organizations working to end preventable maternal, newborn, and child mortality at home and abroad.

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About Global Health Council

Established in 1972, Global Health Council (GHC) is the leading membership organization supporting and connecting advocates, implementers, and stakeholders around global health priorities worldwide. GHC represents the collaborative voice of the community on key issues; we convene stakeholders around key priorities and actively engage with decision makers to influence global health policy. Learn more at www.globalhealth.org. Follow GHC on Twitter or “Like” us on Facebook for more information.

Media Contact

Elizabeth Kohlway
Communications & Member Engagement Manager
Global Health Council
(703) 717-5251

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Microbicides: Innovative Solutions to Help Women Stay HIV-Free

This guest post was written by GHC Member International Partnership for Microbicides (IPM). IPM is a nonprofit organization dedicated to developing new HIV prevention technologies for women and making them available in developing countries where the epidemic has hit hardest. IPM collaborates with a global network of public, private, philanthropic, academic and civil society partners to develop products designed to empower women with the tools they need to protect themselves against HIV and improve their sexual and reproductive health, so they can live healthy and productive lives.

Why do women continue to be at high risk for HIV? Social expectations, cultural norms and economic inequities all limit women’s ability to negotiate safe sex practices, or even select their partners or the timing of sex. Condoms, while highly effective, are simply not a feasible option for many women. Women are also biologically more susceptible to HIV infection than men.

As a result, HIV/AIDS remains a serious epidemic among women. It is the leading cause of death globally in women ages 15-49. In sub-Saharan Africa, infection rates among women are alarmingly high—young women there are at least twice as likely to become infected with HIV as young men, putting their sexual and reproductive health at risk.

How can we stem the tide of HIV infection among women?
Women urgently need new prevention options, particularly discreet methods they can use without partner involvement. Among the most promising women-centered products are vaginal microbicides, biomedical products being developed to protect women from HIV during vaginal sex. They could come in different forms—such as a monthly vaginal ring developed by the International Partnership for Microbicides (IPM) recently shown to reduce women’s HIV risk—and other products in early development like films and tablets.

The flexible silicone ring, which women insert and replace themselves each month, slowly releases the antiretroviral drug dapivirine over the course of a month.

IPM’s dapivirine ring is the first long-acting HIV prevention method shown to safely reduce HIV risk and is under regulatory review.

What are the next steps for microbicides?
Several vaginal microbicides are being studied in preclinical studies or early-stage clinical trials. The most clinically advanced microbicide is IPM’s dapivirine vaginal ring, which is currently in open-label studies following late-stage efficacy trials. At the same time, IPM is seeking regulatory approval to license the product for public use. The monthly ring is under review by the European Medicines Agency and will be submitted to the South African Medicines Control Council and US Food and Drug Administration in 2018, followed by applications to additional regulatory agencies in Africa. The first regulatory decisions on the ring could come as early as 2019 in some African countries. If approved, the dapivirine ring would become the first microbicide licensed for HIV prevention.

Multipurpose products are also being developed that would offer women increased convenience by combining STI prevention and contraception in a single product. IPM has designed a three-month HIV prevention-contraceptive ring that entered its first safety clinical trial earlier this year.

 

How do microbicides fit in the HIV prevention landscape?
No one product will end the HIV epidemic. Women need multiple prevention options that they can choose from that makes sense for their lives, from monthly vaginal rings to daily oral ARV pills to products still in development like vaccines. Modeling studies show that a safe and effective microbicide like the dapivirine ring would have a significant impact on the epidemic while empowering women with tools they need to protect their sexual and reproductive health. And when women are healthier, so are their families and communities as a result.

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The Complex Truth of Health Tech: Why Greater Ultrasound Availability Doesn’t Always Benefit Patients

This post originally appeared on the NextBillion website. This guest post was written by Catharine Taylor, Vice President of Health Programs at Management Sciences for Health (MSH), along with fellow colleagues Dai Hozumi, Senior Director for Health Technologies and Joann Paradis, Strategic Communications Advisor. MSH is a nonprofit global health organization and Global Health Council member organization. 

A pregnant woman is given an ultrasound. (Photo Credit: Rui Pires)

Advances in health technologies have reshaped the lives of communities, families and individuals, undoubtedly contributing to better health outcomes around the world. For the most vulnerable populations, technology may significantly improve access to preventive, diagnostic, and treatment services and help increase demand for greater quality care. Yet, despite their potential, new technologies can also add new challenges, risking potential gains in quality, safety or cost. Particularly in settings where health systems are weak, the introduction of technological interventions requires thoughtful execution.

Take the case of ultrasound technology. Used during routine antenatal visits, ultrasound scans have the potential to change the scenario for many pregnant women who face complications. If combined with proper skills, knowledge and quality-assurance, this technology could help identify high-risk pregnancies and establish an accurate gestational age in order to improve obstetric care. Many low- and middle-income countries are seeing a rapid introduction of this technology into their health systems, accelerated by a dramatic rise in demand that has been driven in part by medical staff, local advertising, falling prices, and a greater availability and range of ultrasound devices.

Yet ultrasounds are not proven to lead to better outcomes for women and newborns in low-income countries, and without the proper focus on their introduction and use, we risk the efficiency and effectiveness of health systems and expose women and newborns to unnecessary technological interventions. That’s why, just last year, the World Health Organization (WHO) issued recommendations on antenatal care endorsing one scan in early pregnancy in low-income countries alongside guidance for staff training and proper use of this technology.

THE REALITIES ON THE GROUND

We recently visited a health center in the outskirts of Kampala, Uganda’s capital city, which had just introduced an ultrasound machine for antenatal care. Like many others, the doctor at this health center was looking to take advantage of this imaging technology to provide better care to his patients. Despite the guidelines calling for only one ultrasound scan in early pregnancy, a woman we met proudly shared with us four photographs she obtained through repeated scans, even though there were no abnormalities or issues identified throughout her pregnancy. We’ve encountered instances like these in several countries, bringing into question essential governance aspects including the right policies, oversight, and mechanisms for evidence-based decision-making, and highlighting potential ethical issues around the use of this technology. Was the doctor equipped with the right skills or understanding behind the proper use of ultrasound? Were there additional unnecessary costs and burdens for the woman and her family, who may have been lulled into a false sense of security that repeated scans would ensure a better outcome for mother and baby?

Given the WHO recommendation and the ubiquity of ultrasound devices, the real question becomes: How do we ensure health systems are robust enough to effectively and safely take advantage of this technology?

There appear to be major gaps in policies, planning and oversight to support the introduction of ultrasound technology, especially outside the more specialized hospital setting. At Management Sciences for Health, we support governments in their efforts to build strong adaptive systems that meet the needs of the populations they serve. The case of antenatal ultrasound highlights three specific issues:

Adequate procurement and a strong supply chain: Our experiences in helping governments improve procurement and supply chain management highlight critical issues that affect how technology takes root and delivers on its potential. Ultrasound technology has advanced to allow for different types of imaging and functionalities, ranging in price from USD $2,000 to $15,000. Determining which one meets the specific needs of a local health system requires thoughtful procurement policies and effective distribution and placement. In addition to regular supplies such as jelly, paper towels, printers, etc., the processes and costs required to maintain the accuracy and sensitivity of the ultrasound equipment, including servicing malfunctioning machines, must be carefully considered within health systems – and these are influenced by the machine specifications. Of course, power supply requirements are also important considerations for health centers that frequently experience electricity outages and voltage fluctuations.

A well-functioning referral mechanism: Because the effectiveness of this intervention relies on the ability of screened women to seek care depending on the screening results, it is also essential for a functional referral system to be in place. Health workers and sonographers must be able to support informed decision-making, and women with high-risk pregnancies must be able to reach the referral hospital – one which must be equipped to handle the level of care that screening indicates, including emergency obstetric and newborn care. The value of the ultrasound screening is diminished when this is not in place, or when women are unable to cover the additional costs of transportation and hospital care and treatment. As illustrated in a study published recently on the implementation of ultrasound technologies in the Democratic Republic of Congo, these challenges represent enormous barriers for the most vulnerable populations.

Strong governance for health: As a screening tool, the ultrasound depends on a process or a decision-making algorithm that allows health workers to adequately act on the information gathered. Nurses and midwives – the cadres who might typically perform this intervention at health centers – must have the policies, consistent training and ongoing supervision to use the technology, analyze the results and take appropriate actions. These elements, and a sound system of quality assurance and data management, will protect the health of women and newborns and prevent health workers from misdiagnosing patients.

Above all, to realize the power of technology in any setting, but most importantly in low-resource countries, we must understand their specific circumstances, and support governments to establish appropriate policies, good governance, and ethical standards as a foundation for appropriate use of technology. This requires structural changes within the health system, and partnership with businesses involved in the manufacturing and selling of ultrasound devices. Only then can we ensure that ultrasound technology – or any technology – delivers on its promise.

 

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Advocacy Update – September 25, 2017

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

House passes Mini Omnibus for FY18

In mid-September, the House made unexpected progress in the annual appropriations process, and passed a mini Omnibus bill, made up of eight spending bills, for Fiscal Year (FY) 2018. The Omnibus included funding for global health in the State and Foreign Operations and the Labor, Health and Human Services, and Education sections of the bill. To put this in perspective, the last time the House completed the appropriations process before the end of the fiscal year was in 2009.

Overall in State and Foreign Operations, which funds USAID and the State Department, funding for global health programs decreased slightly ($8.3 billion for FY18 compared to $8.7 billion for FY17). While most global health programs were flat funded, Family Planning had a 25% cut at $461 million. In the Labor, Health, and Human Services section, top-line funding for NIH increased by $1.1 billion to $35.2 billion. For the CDC, the Center for Global Health was flat funded and funding for the Center for Emerging Zoonotic and Infectious Diseases slightly decreased.

Global health also received some attention in the amendment process. Representative David Engel (D-NY) introduced an amendment to increase funding for TB at USAID from $241 million to $450 million. Although the amendment failed, it was an opportunity to highlight the need for additional funding for TB. Representative Claudia Tenney (R-NY) proposed an amendment to increase funding for community block grants by offsetting funding for CDC global health by $14 million, which could have had an impact on the Center for Global Health’s ability to respond during an outbreak. After a floor debate on the need for increased funding for CDC community block grants, the amendment was withdrawn.

The Senate, while not as far along as the House, has made gradual progress on appropriations. Earlier this month, Congress passed a Continuing Resolution to keep the government funded through December 8, giving the two chambers time to negotiate the differences between their respective spending bills. For the latest on appropriations in the Senate read the Advocacy update from September 11.

View the full Funding Chart.


FY19 Budget Recommendations

Although we are still waiting to see how the FY18 budget process will play out, work has already begun on the FY19 budget. It is our understanding that the Office of Management and Budget (OMB) instructed federal agencies to use the FY18 President’s budget as the starting point for coming up with their requests for the coming fiscal year. The President’s budget cut foreign assistance, which includes the global health accounts, approximately 30%, so we can expect to see similar recommendations in the FY19 budget.

In late August, GHC sent to the Office of Management and Budget (OMB) recommendations for FY19 for the global health accounts at USAID, State Department, as well as the Center for Global Health at CDC, and a few key accounts at NIH. Recognizing the limitations placed on the agencies, GHC recommended at a minimum funding levels that match FY17 levels (for a few accounts, GHC used the House FY18 number if it was higher. At the time, the Senate numbers were not available), but also included higher funding recommendations to demonstrate what is needed to have the greatest impact.

GHC met with OMB in early September to discuss our recommendations and why investing in global health and development is critical.

To compare the FY19 recommendations with the President’s FY18 budget, please refer to the full funding chart above.


Civil Society Recommendations for Six-Month Review of Mexico City Policy

Global Health Council released a statement of principles, endorsed by over 100 civil society organizations, on the upcoming six-month review of the impact of the expanded Mexico City Policy. The State Department proposed a six-month review of the policy’s impact on U.S. global health programs, which have saved and improved the lives of millions around the world. As the timeline approaches for the six-month review, the statement of principles provides recommendations for a review that is meaningful and comprehensive, and proposes an annual review to understand how the policy affects U.S. programs and their outcomes long-term. Read GHC’s press release.

GHC has shared and discussed the statement with State Department, USAID, and others.


Redesign Process: GHC Releases Statement on Importance of Global Health

Earlier this month, federal agencies submitted to OMB their proposals for a “redesign” or restructuring of their respective internal structures, including offices, programs, etc. The foreign assistance community has been closely following the process as it relates to the State Department and USAID, and the role that foreign assistance will have in U.S. engagement globally.

While the process has not been entirely transparent, civil society was invited to several stakeholder listening sessions to provide comments and ask questions of the “Redesign” team at State and USAID. These sessions were not entirely productive as the community was not provided detailed information on the team’s specific plans for restructuring, making it difficult to provide meaningful comments.

GHC released a statement, endorsed by a number of organizations, to USAID and State emphasizing the importance of global health in development. As we did not have details on how, or even if, global health programming would be restructured, the statement is purposely broad. The statement was also shared with OMB, which will make any final decisions on restructuring.

It is unclear at this time, if any of the proposals will be shared publicly, but watch this space for updates as the process moves forward.

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