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The WORLD’s FIRST Surgery Live Stream from MONGOLIA

This guest post was provided by GHC Member, The University of Utah

On September 27, Dr. Raymond Price, from the University of Utah Center for Global Surgery, and Dr. Sandag Erdene, from the Mongolian National University of Medical Science (MNUMS), performed a laparoscopic surgery broadcast live in 360-degree/virtual reality from Töv Province, Mongolia.  The live stream, in virtual reality via GIBLIB, allowed a unique view of the entire operating room – the surgeon, staff, all around the room, as well as zooming in to see more detail.  A global classroom of students from 40 countries tuned in to watch and ask questions.  The event marked the first-ever use of a low-cost laparoscopic technology in a low-cost teaching environment.

The physicians used a medical device invented on the University of Utah campus.  The tool was designed to make laparoscopic surgery affordable anywhere in the world, costing consumers a fraction of the per procedure cost of current laparoscopic technology on the market.

UUHC Physicians Guide Future of Emergency Care in India

Emergency medicine is a brand new concept in many parts of India, where emergency care skills are not well taught or represented in many Indian medical school curricula.  Peter P. Taillac, M.D., and Vijay Kandula, M.D., M.P.H., AAHIVS, have developed a “train-the-trainer” course that is modernizing emergency care in Karnataka, India and is now slated for use in other developing countries. Taillac and Kandula first conducted a needs assessment to learn the kinds of emergency injuries and illnesses common to the region.  They then developed a Comprehensive Emergency Care and Life Skill Support training program – a four-day course for medical students and five-day course for trainers.

The course is highly interactive and encourages students to actively participate with questions – a didactic method of learning that is new to most students. The schedule involves morning lectures followed by hands-on case-based scenarios in a skills lab, which, in this context, is also a novel approach to training. The focus is on learning skills, and students are encouraged to treat the test as another opportunity to learn.

In addition to medical students, current doctors will have the opportunity to take the course – as the Ministry of Health in Karnataka has allocated funds to train 400 doctors.  Since the program began two years ago more than 200 trainers have passed the course.  By year’s end, Taillac and Kandula expect to have certified 3 medical schools that will be able to teach the course independently. Aiming for sustainability, they hope to certify at least twenty schools in the next three years.   As the course builds knowledge and skills in the doctors and medical students they expect to see lower mortality rates in injury and illness.

Why we’re all talking data

By Assumpta Nantume, Communications Associate, Global Health Council

U.S. Vice President Joe Biden speaks at the United Nation’s Social Good Summit in New York on September 19. Photo Credit: Stuart Ramson/UN Foundation

U.S. Vice President Joe Biden speaks at the United Nation’s Social Good Summit in New York on September 19. Photo Credit: Stuart Ramson/UN Foundation

At last month’s United Nation’s General Assembly (UNGA) week in New York, world leaders and development partners made a strong demonstration of global commitment and partnership on data production and utilization for sustainable development. This subject was a central theme at both the main UNGA session and other side events held throughout the week.

While different experts hosted conversations to analyze current approaches to address climate change, gender disparities, global health threats, and other challenges, they echoed in emphasis that the prospect of seeing dramatic change and meaningful progress on any of the 17 Global Goals, or Sustainable Development Goals (SDGs), relies heavily on our ability to harness good data to inform decisions and focus strategies.

Notably, in his address to the United Nation’s Social Good Summit, U.S. Vice President Joe Biden dove into the critical need for data to drive social progress and improve cancer outcomes in low- and middle-income countries. He unveiled “The Next Steps for the Cancer Moonshot Initiative,” – a plan which incorporates a collaborative effort with five nations on international cancer research and care.

The Cancer Moonshot Initiative aims to increase global access to cancer prevention, detection, and treatment methods through these newly formed alliances. The initiative, which was launched in the U.S. in January 2016, has paved the way to make available an unprecedented international dataset to advance cancer research and care. This new alliance will further support the standardization of cancer-related data and facilitate the merger of parallel information.

“We have the technology today to make large amounts of data more readable and accessible than ever before,” stated the Vice President during his announcement at the summit. Vice President Biden also called for a change in allocation of “research dollars” to direct more funding to institutions that are willing to deliver data. He underscored the need for scientists to account for the large investments that go into their research through measurable results and timely publication of new data. The Vice President’s speech was just one of many moments at this year’s UNGA week that highlighted the key importance of data in any discussion of the SDGs.

For way too long, the limitations in data production, quality, access, and utilization have hampered progress in every single area the SDGs seek to address. However, through new robust and powerful data systems, the world is quickly emerging out of the messy whirlpool of hollow and unpurposed information. The rapid advances and spread in technology and networks across the globe have spurred a data revolution allowing more means and efficiency today, to collect and process key information with greater ease than in the past.

In fact, data collection for many nations is no longer a question of technical capacity, but rather sheer political will. This is why coalitions such as The Global Partnership for Sustainable Development Data have joined forces to galvanize political commitment, align strategic priorities, and foster collaboration in establishing clear data road maps for sustainable growth.

Civil society too, has become increasingly aware that good data means better action, and is employing data as a tool to hold governments and leaders accountable for the promises that they make.

The United Nations Foundation and GSMA recently launched SDGs in Action – a free android and iOS mobile application designed to track universal progress on the Global Goals. The app features detailed information about each of the goals, as well as explanatory videos and suggestions on how to take action. It also provides users with access to data on global and national efforts to address pressing issues, right in the palm of their hands.

With this sweeping data revolution information is becoming more transparent, accessible, and inclusive. Ultimately, data will remain critical in effectively achieving the SDGs.

Five Ways Health Care Workers are Improving HIV Services for their Community in Malawi

This blog was originally posted by Elizabeth Glaser Pediatric AIDS Foundation, and written by Isabel Garcia and Meria Million, EGPAF- Malawi 

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Olipher with her daughter, Cicilia, and twins, Silvester and Sylvia. ISABEL GARCIA, EGPAF-MALAWI. Photo Credit: Elizabeth Glaser Pediatric AIDS Foundation

Despite Malawi’s success in expanding HIV prevention, care, and treatment services, the proportion of people living with HIV who know their HIV status is only 53%; well below the 90% target set in the country’s Strategic Plan for HIV and AIDS. Malawi aims to meet the ambitious 90-90-90 targets released by UNAIDS in 2014.

To reach the target of diagnosing all (or at least 90% of) people living with HIV, Malawi is scaling up provider-initiated testing and counseling (PITC).

In order to meet facilities’ needs for more staff dedicated to HIV testing and treatment services, Malawi organized a small group of lay citizens to be trained as HIV diagnostic assistants (HDAs) to focus on PITC, identification of people living with HIV, and linkages to care and treatment.

With funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC), EGPAF-Malawi engaged two local organizations, Lighthouse, and the Malawi AIDS Counseling and Resource Organization (MACRO), to recruit, train, and deploy 164 HDAs to 63 priority health facilities in seven districts.

HDAs provide HIV testing and counseling at health facilities, but at Ekwendeni Community Hospital, HDAs are exceeding their duties to enhance HIV services for their clients. Here are five ways that HIV diagnostic assistants at Ekwendeni Community Hospital are helping to end AIDS:

1. Diagnosing Mothers

With the help of HDAs, Ekwendeni Community Hospital increased HIV testing services at the antenatal care (ANC) clinic for pregnant mothers by 184%.  Ekwendeni tested 1,841 women at ANC from January to June 2016, almost twice as many as were tested during that same time period in 2015. Olipher Nkhata, a then mother of two, was pregnant with twins when she was offered an HIV test at her antenatal appointment. She tested positive, and was started on antiretroviral therapy (ART) that same day.

2. Ensuring Supplies are Always Available

Stock-outs, or times when HIV testing supplies run out at a facility, can be a common occurrence.  Through the use of a daily activity register, HDAs track supplies used each day, keeping facility drug store in-charge informed of when supplies are running low and reorder from drug store.

Photo credit: lizabeth Glaser Pediatric AIDS Foundation

Photo credit: lizabeth Glaser Pediatric AIDS Foundation

3. Reaching More Clients with HIV Testing and Counseling Services

After the introduction of HDAs at Ekwendeni Community Hospital, 230% more clients received services from January to June 2016 compared to the same time last year. The availability of HIV testing in multiple wards means sick patients do not have to go far to receive services, like Agness Moyo who was tested for HIV by HDA, Joshua Ngulube, when she was admitted into the female ward for feeling ill. Her mother died from AIDS-related illnesses and her father had been on ART, but at 20 years old, Agness had never been tested for HIV. Joshua tested Agness, and learned that she, like her father, was living with HIV. With emotional support and encouragement from Joshua and her aunt, Agness started ART and is now beginning to accept her status.

4. Linking Youth to Services

Ekwendeni Community Hospital has two active youth clubs, both clubs meet once a month and have about 50 members each.  Topics discussed amongst youth each month include: psychosocial support techniques, goal setting, nutrition, drug adherence, and reproductive health. In addition to offering testing services at the hospital, HDA Joshua Ngulube also coordinates both clubs.  He advocates for his clients, like Agness, to participate in the clubs as a way to gain knowledge and acceptance of their status amongst peers.

5. Providing Peer Support for Community Members

Photo credit: lizabeth Glaser Pediatric AIDS Foundation

Photo credit: lizabeth Glaser Pediatric AIDS Foundation

HIV positive clients often admit to HDAs that health facilities can be intimidating due to stigma against people who are sick. HDAs are normally from the communities in which they work, and their familiarity with clients makes them more approachable. HDA Victor Kaluwa explains that through his work at the health facility he communicates to peers that spending time with a person who is HIV-positive “doesn’t mean you’re exposed.” Victor makes a point of visiting and sharing meals with his clients. His congenial attitude in and out of the hospital makes him accessible to his clients, opening the facility doors to those otherwise fearful of pursuing HIV testing and counseling services.

Robert Mogha, Health Management Information Systems Officer at EGPAF-Malawi, works to monitor the success of the HDA program.  He says, “Since introducing HDAs to EGPAF facilities, we have seen a significant increase of the number of mothers attending the clinics and those identified as HIV-positive. HDAs have become a crucial facet to helping Malawi reach our first 90 target, and we couldn’t achieve it without them.”

Strengthening the Future of the Worlds Youth: Ensuring Health Equity

By Lanice Williams, Policy Associate, Global Health Council 

During the recent UN General Assembly, NCD Child, a global coalition of stakeholders focused on ensuring the health and well-being of children, adolescents, and youth with a particular focus on young people who are living with or at risk of developing non-communicable diseases (NCDs), hosted a side event on “The Global Strategy: Ensuring Equity for Our Adolescents.” The event was in coordination with American Academy of Pediatrics, Secretariat of NCD Child; the World Health Organization; UNICEF; and the Partnership on Maternal and Child Health (PMNCH), and focused the discussion between youth and leaders on the unique challenges that affect adolescents’ health and how we can ensure health equity.

These organizations advocate that youth involvement is vital in helping to develop sustainable positive health outcomes, which is supported by The Global Strategy for Women, Children, and Adolescent Health. The panel discussion focused on the Global Strategy’s three pillars – survive, thrive, and transform – with a particular emphasis on engaging, empowering, and expanding youth participation in preventing NCDs and premature deaths. For many years, NCDs have been viewed as a health problem that typically affects adults. However, adolescents under the age of 18 are shown to be at increasing risk of developing NCDs such as diabetes, chronic respiratory disease (i.e. asthma), and cardiovascular disease. These conditions, in turn, affect the development of a child which could lead to premature death.

Currently, there are 1.8 billion youth (those 25 and under) worldwide, and it is estimated that 13% of them will die each year from an NCD before reaching their 20th birthday. Bente Mikkelsen, Secretariat, WHO Global Coordination Mechanism on NCDs, spoke about the need to address the gaps in reducing the incidence of NCDs and its long-term effects on youth. Some of these gaps include: access to quality healthcare, interpersonal violence, sexual health, mental health, and inadequate nutrition. In order to close the gaps, global health practitioners must address ways to increase investment in adolescent health and NCDs; increase the visibility of NCDs affecting adolescents on the global agenda; and address NCD-related behavior among adolescents. Without addressing these gaps, which often start in childhood and early adolescence in many low- and middle-income countries, youth will continue to experience the long-term effects of NCDs, such as diabetes due to the lack of a nutritious diet or cancer-related deaths from tobacco.

“We need youth voices to be included in the prevention of adverse health outcomes as they are a powerful change agent in getting their peers to become more aware of behaviors that continue to put them at risk of NCDs,” stated Charity Gichobi, Training Coordinator, The Youth Banner. By creating youth advocates, there can be a break in the cycle of poor adolescent health, a reduction in stigma, increased knowledge, and demands for policy change.

All four panelists agreed that youth are an unplugged resource in beating NCDs. More programs and interventions are needed that reduce the burden of NCDs, and these should be aimed at addressing risk factors and behaviors that are developed during adolescence, which in turn leads to larger health issues as an adult. These approaches must also be integrated throughout communities, schools, and among parents and caregivers of adolescents. In conclusion, as we focus the development agenda on strengthening health systems, we must ensure adolescents and children are no longer vulnerable and that their voices are recognized. Youth and adolescents are the world’s future leaders and their input is essential.

The World Commits to the AMR Fight

This blog was written by Danielle Heiberg, Advocacy Manger, Global Health Council and Matt Robinson, MA, Advocacy and Policy Officer, Global Health Technologies Coalition (GHTC)

Photo credit: Matt Robinson, GHTC

For only the fourth time, the United Nations General Assembly (UNGA) convened a high-level meeting focused on health, which was held during the recent 71st UNGA. Following on the footsteps of the recently released “Review on Antimicrobial Resistance” report (commonly referred to as the O’Neill report), member states gathered to discuss antimicrobial resistance (AMR) and global and national commitments to address this threat. The report estimates that by 2050, 10 million people will die every year because of AMR and the rise of “superbugs.”

At the heart of the high-level meeting was an acknowledgement that the threat of AMR is very real, with multidrug-resistant tuberculosis accounting for one-third of AMR deaths every year and some infections, such as gonorrhea, now only treatable using the last class of antibiotics available. Member states want to address today the overuse of antibiotics, both in human and animal health, improvements in infection prevention and control, and supporting R&D that brings new medicines to market, in order to prevent a return to the days when a scraped knee could kill a child.

Before diving into the outcomes of the high-level meeting, it is worth noting a few things that characterized the conversation. First, it is clear that there was a conscious effort on the part of the meeting organizers to use the platform of the General Assembly to reframe AMR as a “One Health” issue where agriculture, animal health, and human health are all aspects to be addressed in an AMR response. And while the World Health Organization (WHO) does not have the authority to direct policy for the Food and Agriculture Organization (FAO) or the World Organization for Animal Health (OIE), the General Assembly does, and it was clear (both from the framing of the summit and the text of the political declaration) that expectations are that the three United Nations (UN) agencies will work together for a coordinated response. Second, the sense of unanimous agreement in the room is something rarely seen at the UN. While there may have been some discussions around the edges of specific technical language, the impression was that member states and UN agencies are on the same page and committed to addressing AMR (unlike HIV/AIDS, for example, where even countries who endorsed the declaration had concerns around some of the action points).

The political declaration on AMR, universally endorsed and formally adopted by member states, specifically calls for:

1. Countries to commit to:

a. Developing appropriate action plans and policies to address AMR.
b. Mobilizing additional resources, including for innovative approaches and R&D.
c. Ensuring that surveillance is part of these plans.
d. Undertaking public awareness and education activities on AMR and the dynamics that drive it (including a focus on patient-driven demand for antibiotics).
e. Utilizing a multisectoral model incorporating innovative partnerships and incentive mechanisms to pursue the “One Health” approach.

2. WHO, FAO, and OIE should finalize a global development and stewardship framework to both protect the effectiveness of current technologies as well as to support the development of new technologies.

3. WHO, FAO, OIE, the UN, multilateral development banks, and all other stakeholders should support the national, regional, and global action plans described above.

4. The Secretary-General should establish a cross-UN coordinating group cochaired by WHO and the Secretary-General’s office to guide efforts on AMR, as well as to prepare a report for the 73rd General Assembly outlining progress and recommendations to accelerate it.

In the context of the recent release of the report of the High-Level Panel on Access to Medicines (HLP), it is also worth noting that concerns around access to medicines are also evident in the AMR declaration. Unlike the broader access to medicines debate, however, there is a clear acknowledgment of the need to discourage overuse of antibiotics to preserve their effectiveness while ensuring that those who need them have access.

Overall, the future implications of the high-level meeting and declaration will depend on what happens next. AMR is squarely on the international agenda and the meeting brought the global community together in an expression of shared desire to fix the problem, which is entirely positive. Unfortunately, shared desire is by no means sufficient to address a problem as complex as AMR. As one panelist said, “If I have three key points, they are implementation, implementation, implementation!” The determinant of the meeting’s success lies in whether the action plans are developed and then acted upon. As for the role of civil society and nongovernmental organizations, holding governments accountable over this is precisely where the global health community can step up through advocacy and mobilizing public pressure to create political will.