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A celebration for handwashing makes smiles in Haiti

This guest blog was provided by GHC member, IMA World Health, and written by Kara Eberle

Mackensia Joseph knows she needs to wash her hands after she uses the latrine at home and at school. The 11-year-old girl understands that she could catch a disease, such as cholera, if she doesn’t.

It’s a lesson that was reinforced during the WASH Fun Day in May at her school, the National School of Lavanneau in Jacmel, Haiti. The event included plays, poems and songs about the importance of safe water, good hygiene, proper sanitation and a healthy environment for everyone’s health.

What do you do after you use the bathroom?” one group of students sang in Creole.

Wash your hands!” the rest of their 360 classmates shouted in response.

Lavanneau is one of 60 schools that will be improved through Healthy Schools, Successful Children project, or Sante nan lekol, se Sikse Timoun yo in Creole. The project, which began in September 2015 and continues through March 2018, is funded by Episcopal Relief & Development and is being implemented by IMA World Health.

The goals of the project are to improve students’ health, school participation and academic success through water, sanitation and hygiene—often referred to as WASH—interventions in the South, Southeast and Grand Anse departments in Haiti. The objectives include improving infrastructure in schools by building latrines and handwashing stations; improving behavior among students, teachers and communities; and building frameworks that enable schools and the community to sustain the progress and maintain the infrastructure.

The longer-term hope is that, by working in schools, good hygiene practices will be absorbed by the wider community.

The Caribbean country known for its music and indomitable spirit continues to struggle with a lack of access to safe drinking water and proper sanitation. Nearly 40 percent of the population still lacks access to improved sources of drinking water and just 26 percent of the population has access to improved sanitation facilities, according to a 2014 UNICEF report on the state of the world’s children. The situation in schools is even more alarming. More than 74 percent of schools lack water installation and 84 percent lack treated drinking water, according to a Ministry of Education report. Fewer than 60 percent of schools have functional toilets or latrines, the report states.

What does that mean?

It means thousands of Haitians have to travel miles, usually on foot across rocky and mountainous terrain, to get to water. Often that water isn’t safe to drink. And it’s usually up to young girls, like Mackensia, to fetch the water for their families, which can interfere with their opportunity to go to school. Mackensia said she carries two, 2-gallon jugs on her 15-minute journey, one-way, to get water for her family.

It means their bathrooms are latrines that are nothing more than holes in the ground. There’s no toilet paper and no seats. Boys likely don’t even use latrines and urinate outside instead. In some cases, boys aren’t taught to use a latrine. It’s a situation the IMA Haiti team is working to change, and the WASH Fun Day was just one of the activities they have planned to improve health throughout the country.

Their main goal is to ensure that each school has access to a sustainable source of safe, clean water. Some schools will get hand pumps, some will get rain catchment systems and others will get reservoirs, depending on the situation. They will also make sure students have safe and improved latrines to use. In some cases, this means they will tear down existing structures and replace them with new ones that include seats and proper ventilation. The team will also train school directors and teachers to implement WASH education in their classrooms, and encourage students to form school health clubs to promote healthy WASH behaviors.

IMA Program Manager Dr. Paul-Emile Dalexis, Assistant Program Manager Dr. Junie Oxiné and Project Engineer Joseph Beneche are carrying out the feat with the help of their IMA colleagues based in Port-au-Prince.

The school spent a month putting together the WASH event, which included every class in the school. Staff members, including Principal Saint Juste Michel Pierre, also participated. One duo performed a hip-hop song about proper sanitation that got all the students on their feet. They clapped along, energized by the lyrics that included when to wash hands and why they shouldn’t litter. Their song also recognized Allison, a 13-year-old girl who donated her wish to help their school through Make-A-Wish® Alaska and Washington.

Another group acted out a funeral for someone who had died from cholera. The performance included many somber, though important, messages, including why it’s not safe to have a burial within 50 meters— about the width of a football field— of a water source.

Students were rewarded for their participation. Dr. Oxiné asked questions and volunteers joined her on the makeshift stage to share the correct answer. Their prize was a bag filled with pencils and hygiene-related items.

Near the end of the program, other volunteers were asked to head to the stage to demonstrate proper hand-washing techniques. Then, all the students lined up – boys on one side and girls on the other – to wash their hands and receive a new bar of soap before they ate lunch.

IMA’s Vice President of External Relations, the Rev. Amy Gopp, traveled to Haiti for the event, along with other members of the team based in Washington, D.C.

“Everything IMA does, we do in partnership,” she told the students and staff. “And we’re happy for this partnership.”

Mackensia is happy, too.

By the end of May, work will begin on her school’s latrines, water systems and handwashing stations to make them safer and cleaner. When the work is done, she will have safe water to drink while she’s at school. She’ll have a place to wash her hands after using the latrine.

She’ll also have the knowledge and tools to promote healthy WASH behaviors at home and in her community, which will lead to a healthier Haiti for generations to come.

Students who attend The National School of Lavanneau near Jacmel, Haiti, wash their hands before eating lunch on May 5, 2016. They spent the morning singing songs, reciting poetry and performing demonstrations about proper sanitation and healthy hygiene. Lavanneau is one of 60 schools where IMA World Health, with Episcopal Relief & Development funding, is improving water, sanitation and hygiene through Healthy Schools, Successful Children project. (IMA World Health/Kara Eberle)

Students who attend The National School of Lavanneau near Jacmel, Haiti, wash their hands before eating lunch on May 5, 2016. They spent the morning singing songs, reciting poetry and performing demonstrations about proper sanitation and healthy hygiene. Lavanneau is one of 60 schools where IMA World Health, with Episcopal Relief & Development funding, is improving water, sanitation and hygiene through Healthy Schools, Successful Children project. (IMA World Health/Kara Eberle)

Partners on the Healthy Schools, Successful Children project are:

Episcopal Relief & Development
Ministry of Education
Directorate of Sanitation
Ministry of Public Health and Population

Learn more about their new WASH program in Haiti and watch A Day of Handwashing Fun.

20 Years of Evolution in Human Resources for Health

This guest blog was cross-posted from Chemonics, and written by Marc Luoma

From the 69th World Health Assembly, Marc Luoma describes how human resources for health transformed from a rudimentary idea to a robust field of practice.

From the 69th World Health Assembly, Marc Luoma describes how human resources for health transformed from a rudimentary idea to a robust field of practice.

The 2016 World Health Assembly (WHA) presents a significant milestone for those of us who work in human resources for health (HRH): HRH has finally been recognized as a foundational principle in reaching world health goals.

This year, the WHA will formally adopt the WHO Workforce 2030 strategy, and designate the National Health Workforce Accounts as the basic data set for HRH informatics worldwide. The WHO Health Data Collaborative is creating an HRH working group, and fit-for-purpose HRH was recently recognized as a necessary condition to reach the Sustainable Development Goals (SDG 3).

With HRH in the spotlight, it’s easy to forget that as recently as the mid 1990s, the public health community had only a rudimentary understanding of how to strengthening the health workforce. At that time, paying attention to HRH meant little more than training health care providers. In these 13 years we have seen elemental changes in the sophistication and effectiveness of our HRH research and interventions.

This transformation began in the late 90s with the realization that training alone wasn’t enough to help providers deliver the best care. The health community began promoting performance improvement approaches to ensure an enabling environment for health care workers, yet the focus was still on improving the individual provider.

Human resources for health milestones since 2004, according to the World Health Organization.

Human resources for health milestones since 2004, according to the World Health Organization.

In the early 2000s a visionary group from WHO called the Joint Learning Initiative (JLI) began to collect data on the health workforce. The group analyzed the number of providers as compared to the population, and the effect on health outcomes. In 2003 the JLI published Human Resources for Health—Overcoming the Crisis, framing HRH as a lynchpin of the health system. With it came the provider/population ratios that we still use today: in order to reach the Millennium Development Goals, a country needs at least 2.8 health care providers per 1000 people. Compared to the National Health Workforce Accounts’ 250 indicators, the 2.8 ratio seems today a blunt instrument. But in 2003 the JLI report served as a wake-up call.

Now, simple provider/population ratios have given way to forecasts of disease burden, provider competencies, geographic distribution, and migration trends. The world of health informatics has evolved from converting paper files to simple databases, to building interoperability among existing government systems such as Civil Service databases, DHIS-2 health databases, and social security insurance data. Beyond basic provider training, we now seek to help existing providers be as productive as they can be. Likewise incentives and pay-for-performance schemes are being coupled with research to maximize the intrinsic motivation providers already feel in serving their communities.

For those of us who have been on this HRH bullet train from the mid-90s to the mid-2010s, it may be tempting to pause for a moment and take satisfaction in how far we’ve come. But let’s only allow ourselves a moment, before digging in for what we hope will be even more accelerated progress in the next two decades.

Marc Luoma is a director and human resources for health advisor at Chemonics International. By promoting meaningful change around the world, Chemonics helps people live healthier, more productive, and more independent lives. 

Funding by crisis is no cure for global health threats

This blog was cross-posted from Global Health Technologies Coalition, and written by Stephen Higgs, American Society for Tropical Medicine and Hygiene and Erin Will Morton, GHTC. 

Aedes aegypti mosquitoes which carry Zika. Photo: Dean Calma/IAEA

Aedes aegypti mosquitoes which carry Zika. Photo: Dean Calma/IAEA

April showers bring standing pools of water, the onset of mosquito season, and a new wariness of getting bitten. In 1999, we were caught off guard when the West Nile virus first appeared in North America. In 2010, an outbreak of dengue fever spread locally in Florida after an absence of 60 years. In 2014, chikungunya first arrived in the United States after travelling breathtakingly fast through the Western hemisphere. Now, in 2016, Zika virus is the latest mosquito-borne disease to threaten Americans. Yet our collective national response continues to be one of short-term planning rather than long-term preparedness.

Since Zika virus arrived in the Americas in May 2015, there has been an alarming spike in reports of birth defects such as microcephaly, particularly in Brazil. Zika infection has also been linked to adverse pregnancy outcomes and Guillain-Barré syndrome—a temporary paralysis that can prove deadly. The World Health Organization has declared Zika a Public Health Emergency.

The virus has now spread to 26 countries, including 312 travel-associated cases in the United States. So far, mosquitoes in the United States haven’t infected anyone, but the Centers for Disease Control and Prevention (CDC) just issued a revised map that shows the mosquitoes that carry this virus and others can be found across the Southern tier of the United States all the way up to southern New England on the East Coast.

Faced with this chilling situation, we don’t have ready the tools we need to fight Zika. Just like with Ebola, crucial tools did not exist or were still under development when the outbreak began. R&D is urgently needed to understand the Zika virus and its associated health conditions, and develop new diagnostics, vaccines, or other treatments to combat it.

A pregnant woman in El Salvador receives an ultrasound as part of the country's response to the Zika outbreak. Photo: Office of the President of El Salvador

A pregnant woman in El Salvador receives an ultrasound as part of the country’s response to the Zika outbreak. Photo: Office of the President of El Salvador

A pregnant woman in El Salvador receives an ultrasound as part of the country’s response to the Zika outbreak. Photo: Office of the President of El Salvador

Today, the Band-aid approach of emergency funding is the only option available to mitigate the crisis. We applaud President Obama’s call for accelerated research efforts, and the need to inform Americans about how to protect themselves, which the CDC has been quick to do. The National Institute of Allergy and Infectious Diseases, led by Dr. Anthony Fauci, has also called for a “full court press” on research.

This requires increased funding for those searching for ways to stop this virus. Diverting resources from the Ebola response, however, is short-sighted. Those efforts are just beginning to show the promise of new diagnostics, advanced therapeutics, and more resilient health systems in Ebola-affected countries. Redirecting funding before the job is finished is dangerous, and will most certainly leave the United States and the world unprepared for the next Ebola outbreak.

The fact remains that this long-standing patchwork approach to global health R&D funding only degrades our ability to respond to the guaranteed next global health crisis. With more than 500 mosquito-borne diseases across this globally interconnected world, the question is not if but when we see another virus or disease.

Just as we need primed and ready firehouses and firefighters, we need a primed and ready research infrastructure. That requires a prioritized agenda and sufficient funding. America’s “firehouses and firefighters” are the National Institutes of Health, CDC, President’s Malaria Initiative and the Army and Navy’s tropical infectious disease programs.

Global health means everyone’s health. It’s time US policymakers stop funding by crisis and commit to sustainable, long-term investment in global health R&D so the most effective health solutions are available when they are needed.

Stephen Higgs, PhD, FRES, FASTMH is the president of the American Society of Tropical Medicine and Hygiene and a professor at Kansas State University.

Erin Will Morton, MA is director of the Global Health Technologies Coalition, a group more than 25 nonprofits that work to save and improve lives by encouraging the research and development of essential health technologies.


Investing in Nutrition: The Foundation for Development

The world is currently not on track to achieve any of the six global nutrition targets that were agreed to by WHO in 2012. The World Bank, Results for Development, and 1,000 Days, with support from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation, did an in-depth costing analysis and investment framework for what it would take to achieve four of the six targets. This brief provides a summary of the analysis of the costs, impacts and investments needed, as well as how donors, governments, the private sector, foundations and others can work to together to finance these investments.

Member Spotlight: AIHM

This post was provided by GHC Member, AIHM 

Integrative Health & Medicine Conference

AIHM is a membership-based organization and the leading provider of inter-professional education to health professionals in Integrative Health & Medicine.

As an organization, AIHM leaders believe that global health professionals must consider the social conditions that perpetuate disease, the undeniable connection that exists between the health of our planet and ourselves, the empowerment of people to be involved in decisions that involve their health, and the use of safe, lower-cost interventions for the prevention and, when appropriate, treatment of disease.

“Integrative Medicine” (IM), or as AIHM favors, “Integrative Health & Medicine” (IHM), is a practice that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches. Integrative health and medicine aims to offer best practices for optimal health and healing. According to AIHM, the integrative approach is, by its very nature, inter-professional.

MEMBER SPOTLIGHT: Dr. Tabatha Parker, ND, AIHM Director of Education.

Dr. Parker is a global agent and connector. In 2015, she was named Physician of the Year by the American Association of Naturopathic Physicians (AANP). Last year, she also received an honorary naturopathic degree from the Canadian College of Naturopathic Medicine and was given the highest honor in naturopathy, “Magister Natura” from Spain for her work advancing naturopathy globally.

Dr. Parker came to the AIHM after establishing a track record of success in Global Health Education and Policy. She was the founding co-chair of the Masters in Global Health at National College of Natural Medicine, the first global health masters offered at a naturopathic medical school, and was previously on faculty at Bastyr University. She is the interim co-secretary general of the World Naturopathic Federation, and worked with the World Health Organization on the WHO Benchmarks for Training in Naturopathy.

Dr. Parker co-founded and was the Executive Director for nearly a decade of Natural Doctors International (NDI), the first and oldest naturopathic global health organization. Her clinical work in Nicaragua on women’s empowerment, cervical cancer screening has been ground breaking. In 2012, she became the first naturopathic physician to graduate as a Faculty Development Scholar from Dr. Ellen Beck’s University of California San Diego’s program, Addressing the Health Needs of the Underserved. As president of NDI, she signed an MOU with the Pan American Health Organization (PAHO) to work together with PAHO, the Nicaraguan Ministry of Health and universities like Utne Reader to help research and implement integrative and traditional medicine into the Nicaraguan national system as outlined in the WHO Traditional Medicine Strategy 2014–2023.

Dr. Parker is naturally funny, unceasingly direct and a true visionary spirit. As an activist for the integrative medicine global health community, she believes holistic healthcare is a human right and works for parity for healthcare providers and full access for all patients to holistic medicine. In her spare time, she loves to dance, sing, and laugh with her husband and two children in Miami, Florida. She is much loved by her AIHM teammates who are deeply inspired by her passion and compassion.

Dr. Parker and AIHM welcomes GHC members to learn more about the Academy and its work at In 2016, there are two conferences where you can connect directly. The International Congress in Stuttgart, Germany (June 9-11) and the AIHM Annual Conference, People, Planet, Purpose, in San Diego, CA (Oct. 30 – Nov. 3).