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Fighting Big Diseases with Little Computers

Treatments for diseases like tuberculosis (TB) and HIV are lengthy and complex. Medications need to be taken regularly and for extended periods. Interruptions come at a high cost for patients, their families, and the health systems that treat them.

Over the past several years, professionals across a range of disciplines have focused on creating solutions at all levels of the health system. From a tool that helps governments calculate the economic cost of medicine stock-outs to a piece of software that allows doctors across Ukraine to follow a patient’s complex TB treatment, technology can play a critical role in bringing solutions to scale and making significant progress in the age-old fight against deadly diseases.

Here are two examples of how MSH is helping health workers use computers to fight back.


To appreciate the importance of having these tools, you might need to be reminded of two things. First, that curing a patient of TB requires a months-long course of antibiotics whose dose and type often need adjusting over the life of the treatment. Even then, success is not guaranteed. Second, if a patient does not finish the complete course of antibiotics, he or she may develop resistance to the medicine. That “stronger” form of the illness—called multidrug-resistant, or MDR-TB—is harder to treat, and is also more contagious. This is, in part, how MDR-TB came to be, and why we’re running out of medicines to treat certain types of TB.

To deal with TB effectively, we need systems to identify it early and treat it appropriately with an uninterrupted course of medicine.

Enter the innovators from Systems for Improved Access to Pharmaceuticals and Services (SIAPS)—a USAID-funded program implemented by Management Sciences for Health that bolsters pharmaceutical management for better health outcomes. They built a web-based digital health technology called e-TB Manager that allows a country’s health system to manage all the information needed for tuberculosis control. The tool enables health workers to monitor in real time the status of TB treatment and flow of medicines by integrating data across key aspects of TB control (presumptive cases, patients, medicines, laboratory testing, diagnoses, treatments, and outcomes). e-TB Manager has been adopted by national TB control programs in 10 countries.

But they didn’t just build the technology. They worked with health ministries across those countries to train users and test, implement, and institutionalize the tool. At the end of it all, they studied user adoption and satisfaction.

Take Ukraine, where TB is among the leading cause of death among infectious diseases. According to a study by SIAPS’s Niranjan Konduri, whose research findings appear in the European Respiratory Journal Open Research, since its implementation in 2008, e-TB Manager has shown strong results: 90% of users, including doctors, nurses, and laboratory professionals, agree that it has improved patient care, and 82% say it enhances productivity.

“I once encountered a situation in the office of a Ukrainian doctor who had to approve for a hospital maternity ward to release a newborn to his TB-positive mother,” says Konduri. “Instead of making time-consuming phone calls to the patient’s district health facility, the doctor was able to swiftly review the mother’s treatment history in e-TB Manager and discover that she had developed multidrug-resistant TB. That information had not been communicated to the maternity hospital. Eventually, the doctor decided to withhold releasing the newborn to the mother until she finished her treatment to protect the baby.”

Seeing such tangible benefits, Konduri explains, goes a long way toward reducing any reluctance doctors and health workers may feel toward adopting a digital health technology.


RESULTS’ Legacy of TB Advocacy

Tuberculosis (TB) is one of the most pressing global health challenges of our time. Despite being preventable and curable, TB kills approximately 250,000 people a year. What’s more, curing TB requires a lengthy treatment period, which is often interrupted by poor access and adherence to therapy. Moreover, multi-drug resistant strains of TB are emerging at alarming rates in several regions across the globe.

When RESULTS began advocating for TB funding in 1997, citing it as a critical health issue and key contributor to poverty, the U.S. provided less than $1 million in global TB funding. Since then, RESULTS has helped members of Congress realize that not only is TB a global epidemic, but the fight against HIV/AIDS will not succeed without an equally aggressive effort against TB. In 2015, U.S. agencies accelerated progress towards a TB-free world by focusing on 10 priority countries and providing treatments to over half a million people with multi-drug resistant TB (MDR-TB). However, it has been six years since U.S. bilateral TB funding has seen a substantial increase, and only 7% of USAID’s global health funding goes to TB.

As we commemorate World TB Day 2017, RESULTS continues to lead advocacy efforts to urge Congress to increase funding for the Global Fund and USAID TB. On March 21, RESULTS will host a briefing, TB kills 5,000 people a day – what are the solutions?, with congressional staff on Capitol Hill. Visit GHC’s online calendar to view details of the event, and other activities happening in Washington, DC around World TB Day 2017. Also, read the TB brief in GHC’s Global Health Briefing Book for more information and key figures on the global impact of TB.

For 35 years, RESULTS has been changing government priorities and people’s lives by combining the powerful voices of citizen advocates with research and oversight of U.S. anti-poverty efforts to shine a light on effective solutions to end poverty.


Global Financing Facility Webinar Series Starts March 21
GHC and the Partnership for Maternal, Newborn, and Child Health (PMNCH) will host the first webinar in a three-part series on March 21 at 10:00 AM EDT to discuss feedback received on the draft Global Financing Facility (GFF) Civil Society Engagement Strategy. The strategy, developed by PMNCH in partnership with the GFF Secretariat, is intended to enhance civil society engagement in the GFF, a multi-stakeholder initiative that supports country-led efforts to improve reproductive, maternal, newborn, child, and adolescent health. The webinar will also provide an opportunity for partners to provide any additional feedback and recommendations. The draft is currently available in English and en Français. Learn more and register for the webinar series.

The Lucky Specials: A Movie Demystifying TB
The Lucky Specials, a film which seeks to educate viewers about the risk, prevention, and treatment of tuberculosis (TB), commemorates World TB Day 2017 on March 24. The movie tells the story of an aspiring cover band from a small South African mining town. On the verge of a huge career break, the band’s hopes and futures are cast in doubt as its key members are infected by TB. The film’s plot expertly addresses several misconceptions, treatment barriers, and stigma related to the disease. The movie makers, Discovery Learning Alliance (DLA), intend to broadcast the film throughout sub-Saharan Africa over the next several months. In addition, DLA is partnering with governments, community health workers, NGOs, schools, and the private sector to reach target audiences. A free download of the movie will be made available to the public in mid-2017. View the movie trailer.

Health Care Crisis in Syria Continues as Conflict Enters Its 7th Year
Last week marked six years of war and turmoil in the Syrian Arab Republic. Since the start of the Syrian crisis in 2011, civil unrest and armed conflict in the country have resulted in a rapidly increasing number of people being displaced both within and outside of Syria. The situation has created serious public health concerns, including: widespread malnutrition, mental health challenges, and low vaccination rates in children under the age of 5. More than half of the country’s health care facilities have been destroyed or damaged during attacks, while two-thirds of its health workers have fled to other countries for safety. Invisible Wounds, a new global report by GHC member Save the Children, highlights the mental impacts and psychological scars the conflict has left on the children of Syria. Read the report and learn how you can get involved in the ongoing response to the crisis.

Workshop on Best Practices for Global Health Experiential Learning
NAFSA: Association of International Educators, the Secondary Field in Global Health and Health Policy at Harvard University,  GHC member Child Family Health International, and GlobalSL will host a workshop at the CUGH conference on competencies, assessments, and other pedagogies of global health fieldwork on April 6 in Washington, DC. The workshop aims to build skills and resources to improve risk-management, optimize cross-cultural learning, deliver effective reflection, and create structures for program management and administration. It will bring together leaders in international and global health education to explore best practices to optimize global health experiential learning. View event and registration details.

Emerging NCD Crisis in Low- and Middle-Income Countries
A new report by The Economist Intelligence Unit examines the growing burden of noncommunicable diseases (NCDs) in developing countries. The report highlights cardiovascular disease, diabetes, and cancer as some of the leading contributors to the global NCD epidemic. It calls on donors to revise allocation priorities and for governments to address the various shortfalls and capacity constraints in their health systems, which limit a patient’s ability to access quality care and treatment. With a shortage of diagnostic tools and trained personnel across the developing world, the report emphasizes the need for innovative solutions such as mobile phone technology to improve the consistency and frequency of routine checks and management of chronic conditions. Read full report.

PQM Increases the Supply of, and Affordability of, Life-Saving Anti-TB Medication

This guest post was provided by GHC member United States Pharmacopeial Convention (USP).

The United States Pharmacopeial Convention (USP) promotes and supports end-to-end quality assurance across health systems in partnership with regulatory authorities, policymakers, donors, and other key stakeholders. Through multiple programs, USP provides technical assistance, workforce development, and sets standards to improve access to quality-assured, life-saving medicines that protect patients. USP’s longstanding partnership with United States Agency for International Development (USAID) has led to significant advancements in medicine quality in priority regions, with key activities currently implemented through the Promoting the Quality of Medicines (PQM) program in 34 countries.

Most tuberculosis (TB) cases can be treated with first line, or preferred, medicines. However, bacteria that cause TB can become resistant to first line medicines, which causes a condition known as multi-drug resistant TB (MDR-TB). In 2015, the World Health Organization (WHO) estimated that of the 580,000 people requiring multi-drug resistant tuberculosis (MDR-TB) treatment, only 20% were enrolled in therapy. For individual patients, this form of TB can mean longer, less effective, and more expensive treatment, which is inhibited further if the medicine provided is not quality-assured. Therefore, increasing supply of and access to quality-assured second line MDR-TB medicines is a high priority in treatment efforts.

Kanamycin is one of the key second line medicines used for treatment of MDR-TB. In 2016, to help increase the availability of quality-assured kanamycin, PQM negotiated the purchasing price with manufacturers based on the costs incurred by the producer in exchange for technical assistance. This intervention had two significant results: the price of quality-assured kanamycin fell, becoming available in liquid form for widespread distribution for the first time to the Global Drug Facility, WHO’s procurement mechanism. The price of 1-g kanamycin solution made available through PQM’s intervention is 73% less than the same product from other suppliers; the intervention also set the lowest price benchmark for 0.5-g and 1-g kanamycin injection solutions on the global public health market, which is expected to drive down the price of kanamycin produced by other manufacturers as well. Ultimately this will enable donors and national TB programs to save millions in public health funding, allowing more efficient and widespread service delivery.