By Carrie Winans. May 13-May 19 is National Women’s Health Week!  This week has been set aside by the U.S. Department of Health and Human Services’ Office of Women’s Health in order to draw special attention to the unique health issues facing women every day.  The week serves as a reminder to schedule regular appointments such as physicals, dental check-ups and OBGYN visits.  It also encourages women to take a fresh start to summer and pledge to get active and change their diet to include the healthy vegetables of the season.

One of the most important things about National Women’s Health Week is the strong emphasis on preventive screenings.  A preventive screening helps separate healthy individuals from persons who may have an undiagnosed condition.  Commonly, tests like mammograms and pap smears come to mind as preventive measures for women.

However, there is another type of preventive screening that women should pay attention to this National Women’s Health Week.  Women should get screened for osteoporosis.  Osteoporosis is the loss of calcium and decrease in overall bone mass.  As a result of this decrease, bones become fragile and break much more easily.  It occurs most often in older women after menopause.  While osteoporosis affects both men and women, women are five times as likely to develop the condition.

The National Bone Health Alliance (NBHA) has made a special effort to increase osteoporosis awareness through their 2Million2Many campaign. The basis of the campaign lies in this fact:  Each year, there are 2 million bone breaks that are no accident, but signs of osteoporosis. Each year, a third of patients with a hip fracture had a prior fracture. After fractures, four out of five women will never be tested for osteoporosis. Osteoporosis fractures will likely cost Americans $25 billion by 2025.

As part of their efforts and in honor of National Women’s Health Week, NBHA hosted a summit yesterday at the Kaiser Permanente Center for Total Health. Moderated by former Congresswoman, tireless health care advocate, and Disruptive Woman Nancy Johnson and the director of NBH David B. Lee, the summit brought new information to the health world.  The summit focused on the specific human and economic impacts of osteoporosis and the NBHA’s plan to reduce bone breaks 20% by the year 2020.  This “20/20 Vision” initiative would implement secondary fracture prevention initiatives throughout the nation. Read the rest of this entry »

By Alanna Shaikh. We used to think that childbirth needed to be sterile, that the best place for a woman to give birth was as clean as an operating room. It turns out, though, that’s not true. A woman’s sense of safety and comfort has a lot to do with a successful birth, and it turns out that being in labor surrounded by people dressed like alien surgeons doesn’t create a sense of comfort and safety.

The best place for a woman to give birth is a clean place. Not sterile – no surgical masks or hairnets – but clean. Free of dirt and bacteria. It minimizes the risk of infection for mother and baby, but it’s also comfortable enough to help a woman deliver calmly.

Unfortunately, many women don’t have a clean place to give birth. For example, they may be giving birth at home, where they have to use old or dirty bedding that they don’t mind being stained by the mess of childbirth and they don’t have a scalpel. Or they may be giving birth at a facility that is too overburdened to stay clean and can’t afford single-use equipment.

There are far too many reasons that women can’t easily access clean places to give birth. That puts women and their babies at risk for infection, especially of the genital tract and umbilical cord. More than a million babies a year die from neonatal infections.

Enter the birth kit.

A birth kit is a set of items intended to make any place into a clean place to give birth. Common things to include would be a clean drape made of cloth or sturdy plastic, a scalpel and clamps to cut the umbilical cord, and sterilizing wipes for hands and surfaces. The kit can be used for home deliveries, or brought to the clinic or hospital to be used there.

Birth kits are the kind of simple, low-cost intervention that can save a lot of lives. There’s not a lot of evidence for the kits right now; the best data review I could locate found only weak improvements in newborn health. The logic of birth kits is sound, though, and the potential for harm is very small. I think as kits are used more frequently, the evidence in their favor will increase.

In fact, I believe in birth kits strongly enough that I’m on the advisory team for AYZH, a social venture that features birth kits as one of their products. AYZH is working to set up a distribution model that lets rural women sell the kits for a small profit. This ensures widespread access to the kits for women who want to buy them, and it provides income to the women who sell them.

Alanna Shaikh is a global health professional currently based in Dushanbe, Tajikistan.

Adele Waugaman

By Adele Waugaman. It’s no secret that the rapid proliferation of social networks and the global spread of the mobile phone are transforming private and public sectors alike. The humanitarian world is no different.

In the music industry, network-centric technological innovations from Napster to Spotify have transformed the way we learn about, acquire, consume, and share music.  Similarly, in humanitarian crises, the democratization of information through connection technologies is enabling new actors to share and act on publicly available data about the crisis, local population needs, and the humanitarian response.

In an increasingly networked world, aid organizations find themselves having to adapt to these new information flows in order to retain their traditional roles at the center of the humanitarian system. These data streams are coming from groups who traditionally have not been perceived as part of the humanitarian sector — from volunteer mapping networks like the Standby Task Force and the Humanitarian Open Streetmap Team, to the local populations themselves.

Why is crowdsourced information helpful in humanitarian emergencies?

Take, for example, the need to locate health facilities after a major disaster.  In response to the Haiti earthquake, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) asked the crisismapping community to locate and plot on a map 105 health facilities whose precise location was unknown (During the earthquake many buildings were heavily damaged or destroyed, including buildings that housed important government data and their curators). Read the rest of this entry »

By Andre Blackman. Achievements over the past several years have moved the needle across a variety of industries. Technology, business, communication, media and a host of others. One area which has been recently getting alot of attention is health care. This attention is being focused on subjects like the treatment and prevention of diseases, the broken structure of the health care system in the United States, the role of patients in the system and taking it to a macro level view – what’s happening around the globe when it comes to health and well being.

Change is here and it’s brewing vigorously.

However, the circle of people who are plugged into these innovations – these changes for impact – are still relatively small. Public health/health care haven’t traditionally been intensely exciting topics. Usually stories of communities dying from a particular disease or suffering from a societal norm that gives an unfair advantage, are covered in the news and even the textbooks. To be fair – those issues are very real but the fantastic part is that there are individuals, organizations and projects that are proliferating wildly across the globe to actually change them. For that very reason, we’ve created the FastForwardHealthFilmproject. Read the rest of this entry »

Governments and their development partners have struggled to address this problem. Many have tried mandating new graduates to provide a few years of service in underserved areas. These programs have met with variable success depending on the governments’ commitment and ability to enforce the plan. Since the publication of the World Health Organization’s well-thought out and evidence-based guidelines on increasing access to health workers in rural areas, some health systems are implementing mid- and long-term solutions such as recruiting and training health workers in underserved communities.

But governments are under intense pressure to solve the problem now. Some have tried rural retention schemes but many of these have been too expensive to maintain long term or scale up to the entire country. For example, Zambia has a rural retention program for physicians, but the program is funded by an external donor (not sustainable) and the salaries are significantly out of proportion with the salaries of other health workers as well as per capita income in the country. These programs also tend to be more expensive than necessary because ministries of health tend to design them without involving the workers in the rural areas that they want to retain or even workers in metropolitan areas that they want to post to underserved areas. The plans have no foundation in evidence. Read the rest of this entry »

By Elita Wong. Both wealthy and low-income countries are struggling with mental health care delivery and access, creating a global dilemma. The evolving discipline of global mental health is a collaborative effort aimed at connecting innovators worldwide with a common interest in improving the lives of people with mental disorders. In many respects, mental health is the key to improving all other health outcomes , given its potential to affect the fabric of communities.

His primary strategy is to use an integrative approach to implement and build the infrastructure for new programs around the world, in consideration of communities that may be under-resourced, under-staffed, and lacking adequate methods of outreach. In a phone interview, he discussed his past and current projects that have showed promising results.

“Part of the solution has to be doing mental health care outside of specific treatment places—in primary care and other community settings. What has been leading edge in providing mental health services is how to creatively divide and distribute the sorts of skills needed to provide care, which means relying on non-specialists to deliver it…” said Dr. Belkin. “Not only doctors, but community health workers and even other members of the community who can be skilled up to take part in evidence-based treatment pathways. This is referred to as ‘task shifting’.” Read the rest of this entry »

By Lois Privor-Dumm. Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the successes and challenges in immunization coverage.   Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed.

Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery (I really like this one!). Read the rest of this entry »

By Glenna Crooks. For all our problems here in the US, we live in a privileged nation, with abundant resources and opportunities to shape a better health future for all people—not just in our own country, but in other countries as well. Our discoveries touch the world. Our communications inform the world. Our health care knowledge reaches out to those beyond our borders. Our public health and clinical care systems are designed to protect us from the ravages of disease that are all too common in many part of the world.

Most people in the world cannot say that. They do not share in the abundance we have come to expect and believe we deserve. They do not have the safe food or sanitary systems that support life, nurture health, and create prosperity. We bemoan the weaknesses of the best health care system in the world by day, and by evening tend manicured lawns and soak in baths with water that is safer and more pure than what most of the world’s population will drink.

Our government is designed to be responsive. Far too many people in the developing world can’t say that. In some cases, their governments have not attended to their needs; in other cases, corruption is so deeply ingrained it is taken for granted. Either way, the people experience barriers to better health that we can’t imagine.

I’ve seen this happen in my work outside the US and believe it’s time those of us in this country wake up from dream-like Disney-tale beliefs of far- away exotic lands. It’s time we realize that some of those far-away lands are nightmares created not only by tropical diseases (and increasingly chronic diseases as well) but by problems made all the worse by government corruption and corruption is a policy issue that requires attention.

We may disagree with our national, state and local governments, we may decry decisions made by important officials, but they do not, I believe, act – or fail to act – in ways that are as irresponsible or corrupt as these few of the many stories I can report from personal experience.

• The risk of being a girl. Women and girls are disadvantaged in many ways. Other bloggers on this site have made that clear. Mortality rates are high and care is limited. When food is limited, it is the girls who go without and when someone is ill, it is the girls who miss school to be caregivers. Read the rest of this entry »

Olaoluwatomi Lamikanra

By Olaoluwatomi and Ufuoma Lamikanra. Growing up in a rural area in Nigeria, the fear of childbirth was a frightening reality. Deaths during childbirth touched everyone in the village where I (Ufuoma) lived. Another death was another tragedy, another reason for the community to be thrown into deep mourning and a helpless acceptance of what was seen as an unavoidable fate. Fifty or so years down the line, the reality is not much different.Women still die from delivery and pregnancy-related causes and there does not seem to be much difference whether it occurs in the urban or rural areas. There are stories everyday of lives lost in teaching hospitals as well as in local health centers. Many more lives are lost when women give birth at home or when they do not have skilled birth attendants in labor.

What are the main causes of death in pregnancy? The same five leading causes of death found anywhere else in the world. Hemorrhage, sepsis, unsafe abortions, hypertensive disorders, and obstructed labor^aa.  Hemorrhage is one cause that has a particularly devastating consequence as we do not have reliable blood banks, and the blood supply is epileptic or many times non-existent. A pregnant woman who needs blood in many instances is at the mercy of friends and relatives who have to donate blood. If she has no friends, family, or compatible blood donors, her life is definitely at risk.

An event witnessed by my husband/my father 35 years ago and still true of the problems besetting the health sector in Nigeria today!

Amina (not real name) was a pregnant woman who was rushed into a general hospital after several hours in labor. Examination at the health facility revealed she had a ruptured uterus. She was wheeled into theatre almost immediately and her uterus was repaired. There was no blood available so even though she had lost a lot of blood she did not receive any. Following Amina’s operation, doctors warned her to lie on her hospital bed but she refused, saying it was strange for a woman to lie down on the bed doing no work. She insisted on getting up every morning to sweep the hospital compound. She did this for a few days and one morning she did not wake up!

Nigeria has a MMR of 840/100,000^a. This rate varies widely with the highest rates of 2420/100,000 in the northern regions^b. As in any other parts of the world, MMR in Nigeria are dependent on where a woman lives (urban vs rural areas) and the female literacy rate^c , which in turn determines her level of empowerment. Is she able to contribute to discussions about her health or are the health decisions left for her husband or in-laws to make? Read the rest of this entry »

I would argue none of the above.

I would say that the key to a great mHealth tool is a great health worker at the helm.

My name is Kate Otto and I work with the World Bank and other partners to develop and test the effectiveness of mHealth tools on health outcomes.  Based on two recent mHealth experiences – one with health extension workers (HEWs) in rural Ethiopia and another with midwives in urban Indonesia – I have noted a recurring lesson in this emerging field: that technology is not the solution itself but simply a means to arriving at a solution.  The people behind the tools are what make the difference between success and failure.

Too often, the sleek and impressive nature of new technologies makes the headlines: how they solve all the problems that human beings tend to mess up so sorely, how they avoid any mishaps in the first place with a fool-proof design.

Yet the truth is, the success of mHealth tools and applications are based largely on the intrinstic motivation of the end user – and how tools can be designed to leverage, not stamp out, that motivation.

Our product in Ethiopia allows HEWs to register expecting mothers and newborns so that they receive back appointment reminders, creating a patient schedule for the HEW and increasing the likelihood that she’ll deliver the proper care at the proper time, ideally decreasing maternal mortality, increasing vaccinations, and decreasing infant and child mortality.  But if a HEW does not deeply care about saving lives, if the tool does not work smoothly with her rugged lifestyle, if she cannot see the immediate benefit of using it over the status quo system, then will she take the effort to use it properly or consistently? Read the rest of this entry »